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Depression

Mental Health Issues

by Kristina Randle, Ph.D., LCSW February 6th, 2022
written by Kristina Randle, Ph.D., LCSW

I’m very sorry if this is all out of place, I’m not sure how to state it. Firstly, I’ve never visited a therapist and i think I should but I’m too scared to ask for one.

So, it all started 2 years ago when I was having issues with school, I am already diagnosed with anxiety by a professional so I struggle a lot with social situations and can be very awkward, this causes me to not have many friends. I moved school at the start of 2020 and have many friends I suppose. But I have trust issues due to my old school and second guess every little thing, then u get upset over seeming nothing.

This went on for ages till I suddenly felt nothing, I don’t feel happy, sad, exited, love or anything. All my emotions are so fake all the time, whenever I laugh it’s forced and so obviously fake. Everything irritates me, like people touching me, touching my chair so it moves the slightest and just overall sounds in general. If I don’t make the sound it annoys me and instantly makes me angry, like I could murder someone angry… all my emotions are in my head and I don’t show anyone I’m angry because I can’t. It’s all bottled up inside and I’m scared one day I’m going to snap and do something I regret, I’m like a ticking time bomb. I don’t care about anyone around me either, I’ve slowly just started not caring about anything. I always help my friends with their problems but I honestly don’t care, it may seem cruel but everything just repeats itself everyday anyway.

Some days I physically can’t get out of bed, I feel like the only way I can be safe is if I stay in bed. My parents say I’m just lazy but it’s more than that and I just know it. I’ve started just not caring about my personal wellbeing, I don’t do anything to take care of myself, except showering. I feel like I’m slowly wasting away and every time I open my eyes, I want the day to end and it hasn’t even started for me.

I absolutely hate myself but I’m too scared to ask for help, I’ve thought on so many occasions like when I wake up, before I sleep, when I daydream or just while I’m laying in bed staring at the floor about how the world would just be better off without me here.

You mentioned that you are too frightened to ask for a therapist, but then said you were diagnosed with anxiety by a professional. I’m wondering how you were diagnosed with anxiety by a professional, if you’ve never seen a therapist. Typically, therapists provide those types of diagnoses. Perhaps you were diagnosed by your primary care physician or your pediatrician. Maybe that’s what you meant by being diagnosed by a professional.

I’m also curious about why, if you were diagnosed with this anxiety, you weren’t offered treatment. Most professionals, when they give a diagnosis, either refer the client for treatment or provide the treatment themselves. It is not clear what happened in your situation.

Your emotional numbness, irritability, anger, bottling up of emotions, feeling on edge, inability to get out of bed, and so forth, are all suggestive of depression. You would need to be evaluated by a professional to determine if depression is an appropriate diagnosis. It’s important to know the truth.

Many teenagers, feel the way you do about asking for help. It can be especially difficult when you first have to convince your parents that there is something wrong. As you noted, your parents don’t seem to think there’s anything wrong. Maybe that is because they don’t know all of the facts. Have you shared this information with them? Perhaps the only symptom they see is you staying in bed for too long, leading them to falsely believe that you’re just a moody teenager who likes to sleep. Do they know that you feel emotionally numb? Do they know that it’s physically difficult for you to get out of bed? Did they know that you feel like you’re going to snap? In all likelihood, they have not been made aware of those symptoms and are making assumptions based on limited information.

The solution to this problem is, to be honest with your parents about what you’re feeling. They need to know the truth. If they knew the full truth, in all likelihood, they would be doing more to help. If you share this information with them and they’re still unwilling to help, then contact the school counselor or another trusted faculty member. They are trained to know what to do in these situations and can help you. Even if it’s the summer and school is out of session, there’s likely a way to get in touch with a school representative via the Internet.

As for feeling frightened about seeking help, please understand that therapists are in the helping profession. It’s what they do. They know how to help people overcome the types of symptoms you are experiencing. They understand that initial sessions will be nerve-racking and are trained to help you feel comfortable about starting therapy. Give it a try and you will see there is nothing to be afraid of.

It’s especially important to ask for help given your belief that the “world would be better off” without you. That element of hopelessness, in your letter, provides insight into the depths of your suffering. The proper solution to this problem is to ask for help. Do it even if you’re frightened. Be brave because it is the right thing to do. I hope that you will give it a try. Good luck and please take care.

Dr. Kristina Randle

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How can I help my depressed brother?

by Kristina Randle, Ph.D., LCSW February 6th, 2022
written by Kristina Randle, Ph.D., LCSW

My 19 year old brother may be clinically depressed. He does not want to take any direction in his life. He does not want to do the typical things that a teenager would normally do. Meaning, he does not want to get a job. He does not want to finish college (he wants to quit). He does not want to get a driver’s license. In fact, he doesn’t seem to think that these types of things even matter.

He is a very intelligent person. He reads quite a bit, mostly philosophy now. And in doing so, he has become very contradictory in his thoughts. He talks in circles and says things such as: “Nothing matters…” and “It doesn’t matter what I do…” He seems to have an answer for everything and seems afraid to admit when he doesn’t know something. He hardly ever smiles. He doesn’t form his opinions or take a stance on anything. He just mopes around and looks very sad all the time. He never has anything positive to say.

This has been ongoing for a few years now. At first, my family and I thought that he was making various excuses for not trying due to a fear of failure. But as time passes we wonder if it’s not something more than that, perhaps a chemical or emotional difficulty he is having. I am very worried because nothing that I or my family suggests seems to help and I think we may be going about it the wrong way. If he is in fact having an emotional or psychological problem, can you provide some advice as to what approach to take with him, i.e. talking with him about it?

Approach him with compassion. Say to him, as a family if possible, that you have noticed that he does not seem happy, motivated or interested in making a life for himself. Tell him that you all are concerned about him and his well-being and suggest that he seek help.

Based on what you have described to me, he does seem to be experiencing some sort of depression. I am not sure exactly how your brother will react to your family’s concerns and the suggestion of a counselor but it is about all that your family can do in this situation. It will be up to your brother to get help and if he is not motivated to do so, there is little that you can to make him go.

According to the Healthy Place website, there are three ways to beat feeling a lack of motivation due to depression, which may be a more useful approach in conjunction with therapy.

1. Identify the Essentials When you’re depressed and lack motivation, you may need to adjust your ideas about what is essential and what isn’t. Doing the dishes is essential; polishing the faucet isn’t.

2. Break Up Large Tasks Into Smaller, Easier Ones Okay, so the kitchen needs cleaning. There are dirty dishes everywhere. But it’s such a huge job when we’re depressed that we let it go and it becomes much worse. And this just serves to make our depression worse because we feel lazy and no good. So instead of telling ourselves, “I’ve got to get this whole kitchen cleaned up,” we should break it down and say, the first thing is to unload the dishwasher full of clean dishes. But this is even too much, so we tell ourselves, “okay, the only thing I have to do right now is unload the silverware.” This is a job we can usually get ourselves to do because it’s short and easy and requires only a bit of our valuable energy. Once we’re done with the silverware, we can leave the kitchen and collapse on the couch until the next time we go to the kitchen for something and break off another small chunk by unloading just the bottom portion of the dishwasher. By doing things this way, it allows us to at least get started on our immediate tasks. Granted, it takes a bit longer using this method, but it’s better than not doing anything at all.

3. Be Positive about Even the Smallest Victories In mental health recovery, any small step should be celebrated. Use these victories to encourage and remind yourself that you can indeed overcome one step at a time. You’ll be able to say, “I know I can do it because I’ve done it before.” When depression causes a lack of motivation, know that you can still beat it.

Your parents could stipulate that he cannot continue to live in the house if he refuses help, and this may act as leverage into getting him into to see a counselor. Your family can also consider seeing a family therapist and getting his or her guidance on how to live with a family member who is clearly in need of help but is not motivated to get it (if this ends up being the case). Maybe your brother would be interested in participating in the family therapy; this would be encouraging.

Talk to your brother as a family, maybe try bringing his friends into the situation and suggest that he talk to a counselor. Best of luck to you and your family.

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Parents Won’t Accept Boyfriend

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP February 1st, 2022
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I really need advice…I’m 26 years old, I have been on in on going feud with my parents for over a year because of my boyfriend. I have known him since I was 7 and we meet in Sunday school. We reconnected about 2 years ago and I’m absolutely in love with him. My parents hate him because of his lack of a college degree, his cultural background doesn’t match ours, and physical appearance. My parents don’t allow him in the house and don’t actually know him. They judge him based on pictures that they have seen and the change in behavior of their once obedient daughter to wild child (apparently). My parents have immigrated here over 20 years ago and unfortunately hold their beliefs tight. My boyfriend has a very good job with benefits, not an alcoholic, doesn’t do drugs, and more importantly is so good to me. They fail to see that, it has become such a bad situation. My mom calls me really offensive names, saying that I am stupid and brainwashed, etc. When she says these things to me I react and I admit many times out of anger, cursing and yelling. I know that is not the way to do it, but I have tried talking to them as adults and civilized. It just doesn’t work. She sends my boyfriend offensive text messages. I really want to be with my boyfriend and I see a future with him. We had a friendship before and I had never had such as strong bond with someone. My parents have this ideal guy in mind for me, rich guy with an education. If it was up to them then I would be in the house until I am 45 when one comes along. I’m not interested, as long as he treats me right then I am ok. Now I am coming to my breaking point. Our arguments and fights are really bad, my family is ashamed of me, my parents are making themselves sick over this. Both my parents say they are going to leave the house and the rest of the family if it continues. I can’t take this anymore. I have a great job and an important year coming up that can be easily ruined with this stress. I really need some guidance because at this point I feel like everyone is just telling me what to do. PLEASE HELP!!!

At 26 you’re being overly influenced by your parents’ emotional reaction. It’s unfortunate that your parents don’t realize that the very way they are treating you is the way they fear your loving boyfriend would be hurting you. They are already doing to you what they dread he might do. They are the ones verbally abusing you and trying to control you by hurting those you love.

The emphasis here is on moving on. If your parents are threatening to leave the home — wish them well. If you have an opportunity to move out, now is the time to do so. The most important thing that your parents are missing is that in the effort to help protect you they are hurting you in the very ways we are trying to guard you from. If you can’t move out now make a plan to leave and stick to it.

Normally I would recommend family therapy, but it doesn’t sound like your parents are interested in this path. I think I would explain exactly where you’re at with them in a discussion. But then make a plan not to live under the same roof. It is time for you to have your own life. The sooner the better.

Wishing you patience and peace,
Dr. Dan

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Lack of focus, anxiety, depression

by Kristina Randle, Ph.D., LCSW January 26th, 2022
written by Kristina Randle, Ph.D., LCSW

Q. I feel this started picking up around 7 to 8 years ago and is just now where I’m not really sure what to do anymore.

I’ve always had a mild issue with concentration. I have a habit of getting sidetracked etc. I’d be in class and notice that I was thinking of something totally unrelated to the lecture and mentally shake my head and try to pay attention (to things I was genuinely interested in to begin with). Some minutes later I’d notice I had dazed off and again wasn’t paying attention. This would happen pretty much constantly through my lectures.

At first, it wasn’t too big of a deal. I was capable of only half paying attention and doing well anyway. It tends to take less effort for me to get most things than it does other people, or so it had always seemed.

However, I’ve gotten to the point where it’s a real effort to even read anymore. I used to read all the time: fantasy, various fiction, textbooks, science books, and even encyclopedias. I always just loved reading (which is probably the main reason I even did well in school to begin with). Now, when I read a book (and this is something that has gotten progressively worse over the years), I can’t focus. I find myself reading the same paragraph (or lines) over and over again. I’ll be reading and notice, I have no clue what the last sentence just said. When I look back I realize I haven’t really read anything for the last couple of paragraphs. This happens repeatedly. I’ve almost completely given up reading for enjoyment which is something that used to take up a great deal of my time, and I have decreasing ability to read for my classes. I’ve also been a horrible procrastinator my whole life. Again, this used to not be as much of an issue. Even procrastinating, I was able to do well. I’ve also been forgetful most of my life (which also seems to be getting worse). I can be thinking about asking someone a question, go to the kitchen to get some water, then completely forget I was going to ask them something. I had one student (I tutor for Java programming) apologize to me by email for saying “horrible” things to me, and I had no clue what she was talking about. All of this combined has now equated to doing poorly in college. I was doing quite well at computer programming, and now find even that difficult. It was something I used to very much enjoy doing. I dread going to class. I dread taking tests. Sometimes I get so worked up over it, I can’t do anything but sit there feeling so sick to my stomach I feel like I’m getting an ulcer or going to vomit.

So, I wind up having to drop a class. But then I can’t show face in class the next time around, because I’m so obsessed with how stupid I look being in a class the second time around. I’m also aware that it’s stupid to be so nervous/upset about such a thing, but it doesn’t change anything. So, I don’t go to class… If I go back to class, I’m “the guy that never attends class” so I don’t go again… and so on.

So, of course now I’m disgusted with myself, because I’m doing poorly in school. And not because it’s too difficult for me… I’ve never felt it is. I just can’t seem to stay focused and motivated.

I’ve always had a poor diet, and when I got out of highschool, I had very little exercise. (On a perhaps unrelated note, I started losing my hair at 18-19.) So, I’ve recently been eating better… and exercising… lifting weights and walking… taking vitamins… but I still feel… I don’t know… dull. At least, when I’m not feeling anxious. This isn’t to say I don’t ever enjoy myself, just that it’s definitely not the norm.

I also started becoming aware that I had kidney stones around that time (19-20). Not actually passed them; just had bad back aches from them (they could be seen on an xray). I didn’t finally pass one until a few years ago (3-4). I was prescribed hydrocodone (narcotic analgesic) for pain relief. That was pretty much useless, so I stopped taking them. I had always been funny about drugs. I get that from my mother. People that used drugs were weak and anything that altered your mentality was detestable. I took it to a further level than she did and abstained completely from alcohol as well. Probably 6 months to a year later I was working on a directed study that required more programming than normal. So, between surfing the web (which I tend to do more and more… you can be doing 10 things at the same time and never really have to pay attention to them all) and programming, I was getting severe headaches. So, scrounging around for some ibuprofen, I found the old unused hydrocodone. I figured it’d at least work for a headache even if it did nothing for my kidney stone pain. Sure enough, not only did the headache go away, but I felt more energetic and able to concentrate. I’d program for hours until it wore off and my headache came back, then I’d take it again and program for hours. It was the first time I felt “normal” in a long time. There was definitely a buzz… but I didn’t care about that. It just felt so good to be able to read and program for hours like I used to and not be unable to focus or feel like I had no energy.

So, here I am now. Today I had a midterm. I woke up early to study some more for it after barely sleeping (I failed to mention throughout all of this drivel that I have a hard time going to sleep which is also something that has progressively gotten worse over the years), but was so anxious about the test, I felt overwhelmingly sick to my stomach. I had plenty of time to study, but couldn’t. 8 hours later and I’m still a little sick. I missed the midterm. So… I’ll have to drop the class… again.

I don’t know what to do at this point, but I know I need to do something. I actually called three psychiatrist offices this morning (which, considering my almost sub-conscious long held views of psychiatry and people that go to psychiatrists, is actually saying something) but none were taking patients. (I hate talking to people I don’t know on the phone, and was getting sick over that as well while calling.) I have always chalked up anything going wrong to laziness/procrastination and figured I just need to “try harder”, but that’s not really solving anything. I guess, after all this, what my question is: how do you go about starting to work towards a solution in this vein? I used my insurance co’s website to look up psychiatrists and was just calling asking if they were taking new patients. I assume that’s kosher? If they ask “what’s the purpose of the visit?” what do you say? It feels like any answer to that question is whiny. Are you supposed to be referred by a dr, or is just calling normal?

A. Instead of trying for the psychiatrist at this point, why not try a therapist. Just as you were looking for psychiatrists through your insurance company website, go back to the website and look for therapists in your area. If you ended up at a psychiatrist, he or she probably would refer you to therapy anyway. I am not exactly sure what medication could do for you at this point. Start with therapy and then, if your therapist believes medication would be helpful, then see a psychiatrist.

Since you are in school, you can also try your college counseling center for help. Most universities have an entire counseling centers staffed with well trained psychologists, social workers and psychiatrists with services specifically designed to help with student problems exactly as you are describing.

It sounds like you are at least partly depressed, it’s getting worse and it is affecting your school work and other areas of your life. It sounds like the way you have lived for years, just is not working for you now. Doing poorly in school is very real. You are not whining. The problems you describe are very real and you should seek help and not put this off.

When you call for help, whether it’s to a therapist, psychiatrist or at the college counseling center, just say that you are having trouble with procrastination and depression. It does not matter very much what you say when you make the appointment, it just matters that you make the appointment. You should keep all of the follow up appointments and get the help you need to live a more productive, efficient and more stress free life. Good luck and don’t let this problem snowball anymore than it has already. Don’t wait another 7 to 8 years to seek help. The sooner you get started solving your problem, the less stress you will experience.

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My Guy Is in Love with My Sister

by Dr. Marie Hartwell-Walker January 18th, 2022
written by Dr. Marie Hartwell-Walker

From the U.S.: I’m 16 and I dated a guy who was 15. I thought he was the most amazing guy and then he told me one day that he couldn’t date me anymore because he thought he was in love with my sister. I met him through her, but she said they had been friends forever. She lied to me and told me that she didn’t like him and then after he broke up with me I saw she was telling him she loved him and he was saying the same. They would talk about sex and I felt so betrayed, then a week later he told me he was sorry. He blames it on his depression and I let him because he had tried to kill himself before and I felt bad for him, but I feel like he uses it as an excuse to get away with things. But I stared dating him again and again he broke up with me and would flirt with my sister. He actually blamed it on him being a guy and I should blame testosterone. This time she told him she didn’t like him and all this other stuff and she stopped talking to him completely.

I still talk to him and he’s all I think about, but he doesn’t even treat me the same anymore. He would ignore me for days, which he never used to. I feel like he’s dragging me along with him. I’ve had problems with depression since I was 13 and I feel it coming back. He’s all I think about and I wake up at 3 am because of him. I feel so used because I showed him my body because he told me I could trust him and I thought I could. I feel terrible and I can’t shake off this feeling. It consumes my whole day. I don’t know what to do because I can’t talk to anyone about it and I have to keep it all bottled inside because my family doesn’t believe that people can be depressed. I really need some help because I just go through my days feeling dead inside.

You are learning a hard lesson, but it is good that you are learning it while you are so young. When someone has demonstrated selfishness and lying and breaks your heart, it’s generally not wise to go back for more. This young man isn’t ready to date anyone seriously. At 15, that’s not surprising. But nature is unkind in that young women are generally more ready to commit than boys of the same age. You invested far more in the relationship than he did.

High school dating is complicated and scary. My guess is that you keep thinking about this guy because you don’t really want to get back into the issues that go with being available and unattached. I con’t blame you a bit for that. But I do think this guy isn’t for you — or anyone else for that matter — until he grows up. Let it go. Take some time to be single. Work on developing your own interests and solid friendships. Remind yourself that you are lovable and interesting and that there is someone out there who will value you and cherish you when the timing is right.

I wish you well.
Dr. Marie

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Mother Daughter Relationship

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP January 9th, 2022
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Growing up, I lived a quite sheltered life because I wasn’t allowed to go out and have friends. This has really affected me even later in life as I have always felt a bit behind socially. I’m naturally shy and a bit of a loner. I don’t make friends easily even though I would like to.
My relationship with my mother is very difficult as she was very controlling and manipulative. When I was young, I wasn’t very rebellious and I stayed home most of the time even though I was dying to go out. My mother knew this, which was easier for her to control me. She told everyone that I prefer staying home and I’m not so much and outdoorsy type. She didn’t have many friends herself back then and was focused mainly on my older sisters and some family members.

I moved out after high school and went abroad and tried to move on from all of this and build a new life for myself. This worked for a while until some circumstances happened that forced me to move back to my hometown and live with my parents.

My mother has changed her life a bit since. She now has a lot of friends with whom she hangs out with almost every day. In my hometown I don’t have any friends at all and the reason for this is that I wasn’t allowed to make any while in high school. I sit at home and I’m very lonely and it hurts that I’m reminded by my past almost every day.

What hurts even more, is that my mother has a busy social life now, which she deprived me from when I was growing up. I should be happy for her but I’m mostly sad because I don’t feel this is fair.

She doesn’t care about the fact that I’ve moved back and she’s out most of the time. I understand that I’ve grown up but it hurts to see that she has improved her life while she ruined mine. She is obviously much stronger mentally and she often tells me that I shouldn’t mind her business. This is just too hurtful for me. I’m constantly reminded by the things that happened to me in my teens and tend to link everything to it. How can I move on from this? (From the UK)

Thanks for writing to us. You need an escape plan. You state your age as 26, so it is time to formulate a plan to develop away from the shadows of your mother. You need a life of your own outside of your mother’s influence. When you moved abroad it worked for awhile — so the next move needs to be planned with an emphasis on what pulled you back. To have this next move be successful I recommend some individual therapy to figure out how to make a move toward your independence, emotionally and socially.

Wishing you patience and peace,
Dr. Dan

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Telling My Parents That I Am Depressed

by Kristina Randle, Ph.D., LCSW January 2nd, 2022
written by Kristina Randle, Ph.D., LCSW

I think I’m depressed and I don’t know how to tell my parents. Please help me. I think I’m severely depressed because I’ve been so disconnected lately. I’ve been growing more and more anti-social, I’m suddenly losing sleep and becoming more irriatable even if I try hard to be nice. I’m also having at least 10 suicidal thoughts per day. Can you tell me how the heck I’m supposed to tell my parents when I can’t stop thinking that they’ll only make fun of me and not believe me? Please?

I’m sorry that you are experiencing a difficult time. Even if you believe that your parents will not react appropriately I would still encourage you to tell them. At this point, you don’t know for certain what their reaction will be. The best way to know is to tell them.

You can try saying something like this: “This is difficult for me to say. I have been concerned about your reaction but I have something very serious to tell you. I believe that I may have depression. I have suicidal thoughts at times. These thoughts are frightening and I don’t know how to handle them. I believe that I need help. I am serious about wanting help. Can you please help me?”

If you do not feel comfortable speaking to them about these issues then consider writing a letter explaining your feelings. You should inform your parents that you wrote to us at Psych Central. You can show them your letter and my response. This might underscore the seriousness of your concerns.

Your parents may not know how to find you help. If not, I have several suggestions. One way is to speak to your pediatrician or family doctor. They can refer their patients to a local psychiatric treatment center for a thorough evaluation. You should be evaluated by a therapist. You can locate local therapists by searching various directories. I would recommend calling five to 10 therapists and speaking with them directly about your situation. You can do this independently but your parents may want to be involved. Lastly, consider speaking to the school guidance counselor. He or she may be able to help you access treatment. The guidance counselor may also be able to speak to your parents on your behalf.

TeensHealth website outlines ways parents can help you when you’re dealing with depression, even if your seeing a therapist.

They include:

“communicate with kindness — and agree to ban hurtful criticism, arguments, threats, and putdowns
remind you that they love and believe in you
show affection
comment on your positive actions and traits
help with homework or projects you’re having trouble with, or get you a tutor
see the good in you and keep expecting good things from you
hold you accountable (kindly, but seriously) for your responsibilities at home and at school
talk through problems with you
make sure you get proper exercise, nutrition, and sleep (it’s not nagging, it’s love!)
do things with you that you both enjoy — walk, play a sport or game, watch a movie, do a craft, or cook.”

“You might need to ask your mom or dad to do these things for you. You can show them this list or come up with your own ideas. You know best what feels most helpful to you.”

“Talk with your mom or dad about actions you’ll both take to help with your depression. Make a list of what you plan to do. Be sure that your plan includes how you’ll do these things:”

“get exercise
get the right amount of sleep and rest
eat healthy food
spend time outdoors during the day
spend time in relaxing, enjoyable activities, especially with the people you love.”

Suicidal thoughts should always be taken very seriously. Mental health professionals understand this and so should your parents. There are ways to access help for your depression but first you need to make your parents aware of how you are feeling. They cannot help you if they do not know what’s wrong. I know that telling them will not be easy but it is necessary for your mental health and wellbeing. I hope this answer motivates you to speak to your parents so you can get the help that you need and deserve. Thank you for your question. I wish you well.

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What Am I Anymore?

by Dr. Marie Hartwell-Walker December 31st, 2021
written by Dr. Marie Hartwell-Walker

I’m 14 years old, I’m aromantic, and I can’t tell what I am anymore. I feel as if I’m not what I should be. I’m… mentally tired. I’m sick of going to school and watching all this knowledge be forgotten. I don’t want it to wasted on me, a person who won’t live past twenty.

Right now, I’m mentally unstable. Which is the only reason why this is being written. I am weak right now, and I am too tired to care. I know writing this is a risk, but maybe it will bring some light to some things.

I tend to use manipulative ways to get what I want. Such as lying and deceiving people or teachers, to maybe get more time on work to maybe get their pity. Or maybe to get them to care… I do find it exciting to watch them buy an act. Though, I am usually bored. I hate being bored even more, I’d rather lose my morals than be bored. They are all so simple minded, if I cry, that makes me the victim. No matter what I’ve done. I’ve learnt that.

Everything is so repetitive. Wake up, school, sleep. Its robotic actually. And I’m tired of it, I dislike change, I do. Anything is better than this life. I will usually do anything for excitement. Though, I hate crowds and talking to adults.

I should say a few big things now. I do self harm. Cutting, is the main way, but I also have tried choking myself, overdosing on pain medication, drowning myself, I’ve even tried drinking. I do those things, without thinking. They just happen.

When I am seriously mad, I tend to go for a walk, without shoes. To see how long it takes for my feet to bleed or until they get blisters. I don’t really know why though. I do it without thinking.

To also add, I do have a inferiority complex towards my sister. Its like I don’t exist. I acted to change, to be myself. I don’t want to be her. I was called her name, compared to her and I hate it so much. Our parents would pay attention to her first, listen to her first, take her side, and it was like i was alone. I hated that feeling. I learned to hate her, my own sister.

What am I anymore?

I wish I could give you a definite answer to your question. I can’t given the limited information in a letter. What I can do is validate that you are troubled and that you need and deserve some help.

Your feelings probably have something to do with your relationship to your sister and whatever caused your parents to seem to favor her over you. The kind of situation you describe sometimes makes a kid do lots of things to make it clear that, yes, she exists too. Feeling so invisible and powerless, you manipulate people and hurt yourself to tell yourself that you do have some power. Although it does help you prove to yourself that you have some control, it isn’t healthy and won’t lead to a positive self-image or a happy life.

If you could have found other ways to feel like you have a place in the world, you would have done it long ago. For that reason, I strongly urge you to get into therapy. Ask your school nurse or guidance counselor how to find a therapist who works with teens and their families. Your whole family needs some help — not just you.

In the meantime, if you need someone to talk to, please call the Boys Town hotline. Don’t be put off by the name. Girls can call too. Counselors are available 24/7 all 365 days a year to talk to teens who are distressed or scared or confused. It’s absolutely free and confidential. The phone number is 800 448 3000.

I wish you well.
Dr. Marie

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Unable to Insert Myself in My Own Sexual Fantasies

by Kristina Randle, Ph.D., LCSW December 26th, 2021
written by Kristina Randle, Ph.D., LCSW

I am a gay male and have been out and confident in my sexuality for over 3 years now. However in the past year or so I have become unable to imagine myself in sexual situations with men I find attractive, or even men I don’t personally find attractive.

I found a loophole to this problem in the form of imagining myself as a woman, but this always leaves me feeling ashamed of myself, as I’m not sure if this inability to imagine myself with another man is internalized homophobia or due to the fact I have very little self esteem.

I suffer with anxiety and depression and I have been out of education and work for over a year now, with very little social interaction, this has left my self esteem and confidence at an all time low.

I see a lot of the gay men I find attractive as too good for me and feel they wouldn’t want to waste their time with someone like me who is vastly inexperienced and not very confident, these feelings are a huge contributing factor as to why I feel I find it hard to visualize myself with them, but then if I imagine myself as a girl I am able to, despite the fact I know they’re gay.

If I am attracted to a straight man I am simply unable to imagine myself sexually with that man unless I imagine myself as a woman.

I feel like I’m just perpetuating my self esteem issues by imagining myself as someone who I see as better in my own fantasies and It’s just making my depression worse. To the point where I won’t masturbate for long periods of time just because I feel terrible when I do.

Just to clarify, I don’t imagine myself as a specific woman, or anyone I know. I essentially imagine who I would be if I was a woman.

I know this question was a little scrambled and I’m sorry if it was confusing. But I really feel horrible about myself at this point and if I could get some advice or someone could point me in the right direction of someone who could give me some advice it would be great, as I obviously cannot talk to friends or family about the subject.

Greatly appreciated.

Sex can be a very animalistic act but for humans it is always more than that. The physical sensations that arise from sexual activity and sexual arousal are filtered, modified and perhaps re-created, all within the domain of the conscious mind. Everything that pertains to you, to your mind, to your development, to your experiences both sexual and otherwise, to recallable memories and also those that have been submerged into the unconscious mind, all of these things interact with the physical to produce human sexuality.

You are both anxious and depressed. Either of these, could have profound effects upon your sexuality both actual and in fantasy. It would be unrealistic to expect that your anxiety, depression, insecurity, lowered self-esteem, etc., would not have a powerful effect upon your sexuality.

As much as we Americans would like to think that we are completely liberated and accepting of homosexuality and gender issues, we certainly are not. Is there universal agreement that someone who identifies themselves as male or female, can use the bathroom reserved for their identified gender? Of course not and our elections surely show that difference. Is homosexuality a vile perversion that condemns its practitioners to hell? Does God hate homosexuals? There are millions of people that say no to both of those questions, but there are also millions of individuals who say yes.

We are surely moving towards a more enlightened view of sexuality but our country is still in transition. We have yet to reach that enlightened destination. You presently exist in that mixed American culture. Could the negativity expressed by many individuals, in our society, towards homosexuality be affecting you, especially at a time of anxiety and depression?

Yes, of course it could.

The first thing to address is your anxiety and depression and all issues pertaining to it. A good therapist will make all the difference in the world. I believe that as you make progress in those areas your sexual issues will also improve. If you follow this process and your sexual issues do not resolve themselves, then you can, of course, see a sex therapist.

In my humble opinion, your sexual problems will be resolved when the more fundamental mental health issues are corrected. I hope I’ve provided some insight into your concerns and I wish you the best of luck.

Dr. Kristina Randle

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I can’t control my anger toward my husband and don’t know what to do.

by Holly Counts, Psy.D. December 24th, 2021
written by Holly Counts, Psy.D.

I was pampered and brought up in my teens, but fell in love, and married in my 18th yr. I have 2 smart children and a loving husband. When I get angry, I am unable to control my anger, I talk continuously and hurt my husband’s feelings and abuse him a lot. The argument continues until my husband apologizes even if he didn’t do any mistakes. I still think him as my lover and I am obsessed with him.

When I am calm, I am the best wife and mother. I get irritated if he ignores me or keeps a rude face. I get provoked very easily. When he ignores me I feel I should end my life or hurt myself for him to feel guilty. One year ago he had a small affair with a girl but I had found him guilty and since it had not gone to a serious relationship, he came out of it and is loyal to me. Now he resides at Bangalore and me at Chennai. I feel insecure and upset when he is away. Though I am convinced that he won’t cheat on me, I am unable to forget the bitter past. He comes regularly during weekends, still I fight with him. I love him more than my kids and parents.

I feel sorry for hurting him so much. Everybody says I am nagging him and I am making his life miserable. I can’t live without him, I want to be happy and make him happy. I am unable to overcome my temper and forget the past. When I am angry I broke ganpathy idol which he had gifted me after marriage. I feel depressed and disappointed when he argues or abuses me. I feel he hates me because of my behavior. Now he has started verbally abusing me when I nag him and doesn’t believe me even if speak nicely to him. There is no peace in our family. The children are fed up seeing all this. I get very upset if he doesn’t come during weekends. I cry thinking of him and I always sleep with his clothes and photos when he is away. I have got a very bad name from my in-laws side that I am ruining his life. I have also verbally hurt them as they had interfered in all our matters. Now they all have abandoned me and they prefer my husband to stay away from me.

My well wishers try to help me when we quarrel but it can’t last long. I understand that I am into depression some times. But as I am alone with my kids, what if I become bedridden when I take medications for that. Because when I am normal, I do all the work for the family. Please help me to overcome this issue. Help me lead a peaceful life. Please suggest to me where I am wrong . Waiting for an early reply.

I strongly suggest you get help for yourself first, then see if the marriage can be saved. I would find a good therapist and have a thorough evaluation both for counseling and medication. You are in more danger of becoming “bedridden” or too unhealthy to function by not getting help than you are by taking medications. Some medications do make you groggy until you adjust to them but most of the side effects are minimal and tolerable with the newer medications.

You have to learn how to handle your anger in healthy ways and communicate without being abusive. I can understand why you don’t trust him if he cheated on you but badgering him for the rest of his life will not fix the situation. Trust takes time to be rebuilt and it takes two people who love each other enough to do the work together. It sounds like the two of you are in a vicious cycle of anger and hurt and are striking out at each other rather than reaching toward.

Sometimes relationships have been damaged too much to repair and you are better off calling it quits and putting your energy into healing and creating a new life. You need to be honest with yourself and listen to your friends and family and do the right thing. The “right thing” thing is usually never the easy thing.
I wish you both luck.

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Nothing Feels Real, Almost Dream Like

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 21st, 2021
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Firstly, here’s some insight into my current mental health state. About a year ago, I had some counselling for bad anxiety involving obsessions and compulsions which was treated successfully. I have not managed to relapse back into the bad state that I was in. I still have anxieties, but nothing as bad as what it was. Recently, I have been under a lot of stress from work, which has been affecting my mood but nothing that has made me feel depressed; I can still go about my daily life with motivation. However, for the past 6 months or so, I feel as though nothing feels real. I look at my hands typing this, I look at my surroundings, and although I can feel these all as physical objects, I feel trapped like I’m in a dream. It feels weird to me being in the present, and when I register this it causes me to feel stressed. Keeping myself occupied is the only way to distract me from spiraling into thoughts about how none of this material world is real.

For more insight, I took LSD twice in February 2018 and April 2018 and that gave me an altered perception of reality. Strangely enough, after these experiences, I felt absolutely fine, better about reality even. I’m not too sure if it’s the immense amount of stress I’ve recently been experiencing that has triggered these thoughts- in the last 6 months I’ve lost 2 people that I know as well as huge amounts of stress from work.

There are many times when I’ve had to pinch myself, feel my surroundings to remind me that I am still in the material world, but sometimes I feel so disconnected from my body, like it’s just my mind and my body is a vessel that I am watching go about it’s day. It has gotten to a point where I need help before my thoughts go too far, I want to feel real again. (From the UK)

The feelings you describe sound like they may be a type of depersonalization or derealization. Naturally, this isn’t a diagnosis, but I think having an evaluation and having a professional rule this out would be a good idea.

Depersonalization/derealization happens when you are often feeling like you are viewing yourself from outside your body and that what is around you isn’t real. It does, indeed, feel like you are living in a dream, and can be very disturbing — mostly because it can feel like you are losing touch with reality. Most experts agree that while it is very uncomfortable it does not mean you are becoming psychotic, as many people fear.

Symptoms of depersonalization include:

  • Feeling as if you are floating outside yourself and that you are more of a distant observer of your body, or your thoughts, feelings. People often report that they feel like they are floating above themselves.
  • Feeling robotic and that you don’t have control of your movements or speech.
  • Your body may feel distorted and your arms and legs may not feel like their normal size.
  • There can also be emotional or physical numbness of your responses to others and the world around you
  • Your memories may not seem like they are yours and lak an emotional connection.

Symptoms of derealization include:

  • The sense that you are unfamiliar, alienated or detached from your surroundings. People often report this like they are living in a dream or movie.
  • A feeling of being disconnected from people you care about, as if you are in a bubble or behind a glass wall.
  • Your world may seem either distorted, blurry, colorless, two-dimensional or artificial, or just the opposite. You may have a heightened sense of awareness or clarity.
  • Time is distorted. Recent events seem like they were much longer ago.
  • Distances and the size and shape of objects can be distorted.
  • Depersonalization-derealization can be it’s own disorder and is more common in people with a history of traumatic events, it can accompany times of severe or chronic anxiety.

Depersonalization-derealization disorder can be severe and may interfere with relationships, work and other daily activities. The main treatment is talk therapy (psychotherapy), although sometimes medications also are used.

Here is a list of things that can help when you are experiencing these symptoms. But, again, my strong recommendation is to have this evaluated by a professional so as to make an accurate diagnosis.

Wishing you patience and peace,
Dr. Dan

 

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Burnt Out, Unsure of What to Do, Uncomfortable Speaking to Anyone

by Kristina Randle, Ph.D., LCSW December 18th, 2021
written by Kristina Randle, Ph.D., LCSW

You will likely decide this is too specific and lengthy to answer. It is more a request for a perspective than it is a question. I am a 21 female undergraduate. My life is well-established: I receive excellent marks, my family is financially comfortable, and I am talented enough that I do not lack in self esteem, yet I consistently feel numb or unhappy, such that when I do feel joy over something, it feels like a drug trip.

I have been increasingly demotivated for the past three years. I am losing energy, and thoughts that often cross my mind are: do I truly benefit the people around me? Am I annoying anyone? Would it affect anyone that aversely if I were to disappear? I put off things like mailing because it causes irrational stress. Missing the bus can set me in a negative mood for the rest of the day.

I have implemented strategies to discourage myself from this practice: I practice yoga, run, draw, am socially involved, and I am studying and traveling around Europe.

The family I spoke with became angry with me for expressing these thoughts, considering my many blessings. The friend I reached out to suggested that I change my regular thought patterns, and that I am addicted to worry. I perceive this as logical advice, but I am not sure why I feel vaguely angry when I hear it.

I do not believe that I have any reason to feel the way that I do, that it is pointless, ungrateful, and melodramatic, as I am surrounded by fellows with larger problems than my own. If I were to guess at a cause, I would agree with my friend; I drove my thoughts in this direction and continued to do so until it became a habit.

My mood has started to affect my productivity. I can’t drive myself to concentrate on independent work, I received a D on my latest exam (I have historically achieved nothing less than a B), and I can’t remember words and concepts in conversation after years of public speech and debate. I feel sluggish. I can’t truly see a way forward from here. I understand that in order to beat this I need to motivate myself, but I am not sure how to, or if I am strong enough in constitution to take any advice that I am given.

You might be describing the symptoms of depression. It is common for people who are depressed to feel the way you do.

You might say that there’s no reason for you to be depressed because you have lived a fortunate life. You may have had good fortune but it doesn’t prevent depression. Of course we should count our blessings, but material things don’t equate to happiness.

If you’re unhappy, then it should be explored with a therapist. Thus far, you have relied on yourself, friends and family for insight and advice. It would be much wiser to consult a therapist who has both specialized training for treating these types of problems and who has the benefit of objectivity. Friends and family can provide social support but they can’t do therapy nor can they effectively be objective.

Your friend believes that your thinking patterns may be the problem. That is possible. Many theorists believe that depression is the result of faulty thinking. In fact, cognitive behavioral therapy, one of the most effective types of therapy for depression and related disorders, is based on the idea that illogical thinking patterns underlie psychological problems. The goal of CBT therapy, in part, is to assess the quality of one’s thinking, and to ensure that it is in line with reality.

Studies have shown that the majority of people, at some point in their lives, experience mental health problems. In other words, it happens to virtually everyone. It is nothing to be ashamed of. When you recognize that a problem exists and you have tried to help yourself, then it is time to seek help from a professional. Consult a local therapist about this problem. If you find a therapist you like and you actively participate in treatment, you will likely see positive results. Please take care.

Dr. Kristina Randle

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Why can’t I just be happy?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 18th, 2021
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Hi I am 20 years old and just recently moved to Chile with my mother after the separation with my step dad. I have always suffered from depression and have taken medication for it but it seems to never work. These past few years it seems that I have gotten worse. I am constantly down on myself never thinking I am good enough. I can’t even remember what it feels like to be happy. I get angry over what my mother tells me are small things but I tell her they aren’t small to me. I am always on a rollercoaster of emotions, I can be having a good time and the simplest thing will bring me down and I am upset the rest of the day.

I don’t have a home anymore and am staying with family and they are constantly taking my things and it makes me so angry and I just want to cry. Whenever I try to explain to my mom or anyone how I am feeling I start to cry. I have gotten to a point where I get so angry I don’t even scream anymore I am just silent and cry. I feel like I am filled with all these emotions all the time and I hate that I feel so sad and angry all the time but it seems like I can’t be happy.

It makes me feel like I am a burden on everyone and it would just be better if I was gone. Why am I this way? Why can’t I just be happy?

I am sorry this has become such a difficult time in your life. Depression is often activated when we feel we cannot control various aspects of our life, and gaining control of the areas we can is typically the key for feeling better.

There are several things we can do to combat depression that I have identified elsewhere. I will encourage you to read through these as a foundation for change.

In a nutshell, some strategies listed in this article include:

“Positive psychology – strategies designed to shift your thoughts and feelings toward a more positive framework. This isn’t a simplistic “think-happy-thoughts” approach, but rather a focused effort at cognitive restructuring of your thought process. The strongest combination to approach depression is therapy combined with an antidepressant. If you do not want to take an antidepressant there are several homeopathic or herbal alternatives that may be helpful. You may want to consider group therapy as a means of supplementing your individual therapy. Group therapy is different in that there is an interactive feature that can’t be duplicated in individual therapy, and it often provides a vehicle for support as you begin to make changes in your life. Your therapist may know someone he or she can refer you to in your area. Meditation – learning how to self-soothe your emotional turmoil is perhaps the most important skill you can learn. Aerobic exercise – the value of exercise in combating depression is very well documented and this is particularly true for any exercise involving aerobic displacement. Review your diet – our emotional life often changes our craving for various foods, which may not have the best impact on our biochemistry.”

The short answer is that coping with a depression is like walking up a down escalator and we must find the tools and the strength to deal with changing our thoughts and attitude as a way of neutralizing and overcoming these feelings. In particular I would encourage the use of the technique called the “Three Blessings” because it can be used as a direct way to start changing your thoughts.

I would encourage you to seek counseling now to develop a support system in your new location. The find help tab may be helpful as international links are included.

Wishing you patience and peace,
Dr. Dan

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I Didn’t Know About My Boyfriend’s Son

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 14th, 2021
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I am 24 years old and met my boyfriend when I was 16. When we first got together it wasn’t a serious relationship and neither of us had any idea it would last this long however I was not aware of him seeing anyone else.

After 3-4 months together I found out that he had slept with another girl after a drunken night which he denied for 4 years and at the time I decided to stay with him as even if it was true, it was only at the start of our relationship.
However, after around a year I heard through friends that the girl he had apparently slept with had given birth to a little boy a couple of months before and she was claiming that he was my boyfriend’s child.

When I confronted my boyfriend he denied it as he was still claiming that they hadn’t slept together (the girl also had a reputation for sleeping with lots of other guys). This drove me crazy and our relationship hit rock bottom.

We eventually got over this but the girl was harassing me every now and again, shouting abuse down the phone and via text messages and social network sites.

When she met her boyfriend it all stopped.

Two years ago I thought I would give it one last try at getting the truth from my boyfriend and he admitted it all. I swore that I would leave him once I made my boyfriend have a relationship with his son as I thought that was the right thing but then when it came it to it I couldn’t end it because I loved him and this was the man that I thought I would spend the rest of my life with and start our own family.

Since his confession, our relationship has become stronger everyday, although, the child’s mother stopped contact when she got a new boyfriend.

Since then there has been no luck in him being able to see his son.

I have forgiven him for not telling me and I thought I had got over the negative emotions of him having a son but recently she has got back in touch with him after splitting with her boyfriend, which is great for both of them, but I can’t get the sickly feeling out of my head that I won’t have his first child and that he shares this bond with someone who he hates and who hates him.

I have met his son and he is lovely and I truly love children and always have but I want to know how and if I can get over this feeling and move on with the relationship that I want as he has changed and is completely honest with me and I know he loves me?

I appreciate you sending this important and yet complex question to us.

I think it is time for you to assess what it is you want in your life and where this relationship is going. The foundation of your relationship was begun by lies, betrayal, and infidelity. These are very difficult traits to overcome and forgive.

While I admire your boyfriend’s eventual honesty, and the fact that you say you’ve forgiven him, the underlying difficulty is the fact that every time there is a problem all of the old hurts will surface. This makes it difficult in particular because whenever his old girlfriend is not in a good place she can start the pot.

I would do two things: First, I would ask yourself if this whole situation is indeed what you want to be coping with — and if it is what you would like for your future within the relationship. I don’t know that these questions have been fully addressed. Second, I highly recommend couples counseling because of the complexity and ongoing nature of your concerns. Each developmental milestone and every unresolved conflict with his girlfriend has the potential of deeply activating the issue. The two of you are going to need excellent communication, which can be fostered in couples counseling.

Wishing you patience and peace,
Dr. Dan

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Panic Attack/Antidepressant Withdrawal or Something Else?

by Kristina Randle, Ph.D., LCSW December 11th, 2021
written by Kristina Randle, Ph.D., LCSW

Hi! I’m a young teen, and I have depression, that I suppose is kinda severe, General and Social anxiety. Around 2 years ago I was put on anti depressants, which have worked pretty well. Around a year ago, I abruptly stopped taking them without really telling anyone. I’m not really sure why, but I did. This was around the holidays, and I was on vacation with family friends in a vacation house owned by some of their relatives. Now, it was a beach house, and, being the middle of winter and family meant that it had not been cleaned beforehand. I was originally sleeping with my friend, but moved to my mom’s bed. My father passed away when I was 9, which caused some underlying anxiety to get worse, along with the typical grief and depression. I slept ok for the first night, but on the second night, I could not relax. It was storming, and an outside swinging door was banging on the wall. This put me on edge. There was one or two old stains on the sheets, and because of that, I started picturing bed bugs or whatever in the bed. (Not hallucinating, just imagining). I then started to get the “bugs crawling on you” feeling, and started sobbing and babbling nonsense. I tend to do that when I get panicked. After around 15 or so minutes, my mom gave me my prescribed lorazapram, and I calmed down and went to sleep. The worst part was when I was on the 5 or so hour drive home. We have a minivan, and I like to sit in the way back to have more space to spread out. My younger sister, 9 at the time, was sitting in front of me. I’m not sure how it started, but for what seemed like most of the drive, I was having a panic attack. But it was different. I also was hitting my sister, hard enough to hurt her, screaming nonsense, and basically having a tantrum. We live in a historical area, and while we passed signs for places I had been, I started yelling at my mom to go to the places. I really have no clue why. It was horrible. I was basically curled up in a ball, screaming and hitting my sister for at least an hour. I really can’t remember much. I’ve had other episodes like this, but not this bad.

The problematic episodes you have described occurred almost immediately after abruptly stopping your antidepressant medication. That might explain your symptoms. One should never abruptly stop taking medication. There are a variety of dangerous reactions that can occur with the sudden discontinuation of antidepressant medications. If you wanted to stop taking your medicine, you should have consulted your prescribing physician.

After discontinuing antidepressants, many people experience physical changes and mood disturbances. People often feel irritable; it can affect their sleep, their balance, their ability to concentrate, and so forth. Discontinuing medication can be difficult. It’s common for people to stop taking their medication when they feel better. When they stop taking it, many of their symptoms return. They fail to appreciate that it was likely the medication that had led to their improvement.

It was a mistake to stop taking your medication without consulting your prescribing physician. I would recommend telling both your parents and your prescribing physician about what has happened. You should also consider adding counseling to your treatment regimen. Counseling is the ideal place to learn stress management and problem-solving skills. Please take care.

Dr. Kristina Randle

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Parents’ Drinking is Hurtful

by Kristina Randle, Ph.D., LCSW December 10th, 2021
written by Kristina Randle, Ph.D., LCSW

My parents enjoy drinking every night which is not a problem, except that my mom changes. She becomes mean and wild. She had to get surgery once and she was intoxicated where she said when she wakes up she hopes she never see’s me agin. Another incident was when she told me all her problems started once I was born. She is constantly hurting me and this has been going oon for at least past five months.I hate smokers because the smell makes me start to gag and she smoked in the house and in my car one day. It seems like she never cares about me anymore. If I talk to her about how I feel she changes for about two day before she goes back to her ways. Im so tired of having such a stressful home life. It honestly really hurts and compared to other people this may not be like a big deal but it is getting harder to cope. I try and stay positive and say how this is a good lesson because I know how not to act and I will not ever hurt my children like this. I just wish she would realize how much she is hurting me by being basically a coma for the past five years of my life. She was here but not really and she would never remember anything the next day. I feel like i am never good enough and if i was she would not act like this and want to escape her life. Thanks!

I’m sorry about what you’re experiencing. In the state of New York, your parents’ behavior would constitute a form of abuse, reportable to child protective services. It is estimated that the majority of cases of child abuse in New York City involve some form of substance abuse. In such cases, the caregivers are more focused on using the substances than attending to the emotional and physical needs of their children. That seems to be what is happening to you.

It is important that you do not take your mother’s behavior personally (i.e. “I feel like I am never good enough and if I was she would not act like this and want to escape her life.”). Her behavior is not a reflection upon you. It has nothing to do with you. She has psychological problems that are motivating her to drink. It is not your fault. You are in no way to blame for your mother’s behavior. You have no control over this situation. It’s up to your mother to receive psychological help to deal with her psychological problems.

You seem to be a remarkably resilient young woman. You have a stressful home life, through no fault of your own, and yet you are able to maintain a positive attitude. Your parents are not well but you are doing your best to cope with this unfortunate set of circumstances.

My advice is to speak to a guidance counselor or another trusted school faculty member about your parents’ drinking. The school faculty can assist you in accessing the proper psychological help.

It’s possible that once the school faculty learns about your situation, they may call child protective services to determine if neglect or abuse is occurring in the home. Obviously, you don’t want your parents to get into trouble; however, their behavior might constitute maltreatment. If so, child protective services would likely mandate your parents to receive treatment for alcohol abuse. It might be necessary to force them to receive the help that they need to improve their quality of life. It would also ultimately improve your quality of life. Please take care.

Dr. Kristina Randle

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Couple with Anxiety and Depression

by Kristina Randle, Ph.D., LCSW December 9th, 2021
written by Kristina Randle, Ph.D., LCSW

I am a male and I’m into a 5 month relationship. We have been having a lot of trouble except for the first month. I have anxiety and she has depression. Given all our issues we decided to take a break where we should text minimally and meet once in 10 days. I got super anxious the second day and i let her know. But she felt like i was insincere about trying the break and i got what i wanted.

I did offer to try it again but i was also upfront about not being sure if this would work for me as I kept thinking that there might not be any relationship beyond the silence.

She felt I was being manipulative as she would not make us go through it after hearing my sob story. I don’t know how to handle these situations and these are very frequent.

We also like each other a lot but the relationship is replete with speedbumps.

The mental health disorders mentioned, may be interfering with your relationship. That’s difficult for me to know with certainty given that I don’t know your personal histories but it may be a possibility.

Part of the issue may be that the two of you don’t really know each other that well. Five months is not a long time. It can take years to truly get to know someone. She may not know you well enough to understand that it was your anxiety interfering with the relationship and not something else.

Relatively speaking, this is still a new relationship and she may not have clarity about whether or not you want to be with her. Since she doesn’t know you well and can’t necessarily decipher your motivations, she’s trying to judge your commitment to the relationship. In her mind, you want out and are not really interested. If she knew you better, and understood more about your anxiety disorder, she might come to a different conclusion.

My question to you is, have you told her about your anxiety? Have you done more than briefly mention it? Have you fully explained to her how anxiety affects your life? If you provided a more in-depth explanation about your anxiety, she may have a more complete understanding of your behavior. She might be less likely to think that it is her that is the problem and instead attribute it to your anxiety.

Think about it from her perspective. A potential mate who she doesn’t know very well, whom she only recently began dating, informed her that he would like to take a break. Often, when someone says they want to take a break, it’s a nice way of breaking up with them or letting them down easy. Your rationale for the temporary break may make sense to you but from her perspective it may seem like an attempt to manipulate her in some way.

It might be helpful to explain your position in greater depth. That might give her more insight into why you are behaving the way you are.

Understandably, that may not be easy to do because it would mean sharing intimate details of your life with her. Many people feel vulnerable when sharing personal information but sharing might bring the two of you closer together. The more information you share with her, the more sympathetic she may feel about your anxiety.

An alternative perspective is that given that she has depression, she may be interpreting your behavior as evidence of something being wrong with her. In other words, she may not think highly of herself and is interpreting your behavior through the lens of depression and assuming that she’s the problem and not you. That’s also something to keep in mind.

When it comes to dating, it can be difficult to fully connect with someone when you’re experiencing anxiety or depression. These disorders can limit your full participation in a healthy relationship. It would be wise for the both of you to consult mental health professionals.

Depression and anxiety are two of the most common mental health disorders in the world. Effective treatments exist which can significantly reduce or eliminate your symptoms. Depression and anxiety are not incurable. They are curable problems. I would highly recommend treatment. Good luck and please take care.

Dr. Kristina Randle

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Burn Victim and Not Happy with My Life

by Holly Counts, Psy.D. December 3rd, 2021
written by Holly Counts, Psy.D.

I’m 15 years old. When I was 13 I was in a bad accident where 30% of my body was burned with 3rd degree burns. Every since that day, I have thought about the accident. My mother is in debt because of me and my mistake. My mother would cry everyday while I’m the hospital and I would listen, feeling terrible. Once I got out of the hospital, I would cry myself to sleep and I had nightmares. I went to school and got ridiculed. I was the kid who “set himself on fire” or “crispy legs.” Let it be known I didn’t set myself on fire, it was an accident. Everyone mocked me and made fun of me. I was stared at and laughed at. Now I feel alone. I haven’t talked to anyone about this and all the feelings and depression I’ve built up over the years. Everyday, all throughout the day I think about my accident. It haunts me and I hate myself for getting burned and hurting my mother financially and emotionally. Recently my girlfriend broke up with me after I told her all of my thoughts and feelings. I would have killed myself if my mom didn’t tell me she was pregnant with my little brother, he seems to be the only reason I’m alive today. Now I just don’t see what the point of living is to be honest. Everyone is so hateful and no one cares about me. I don’t even care what happens to me. Words can’t describe how much I hate myself and how I’d give anything to take back what happened to me. I just don’t see what the point of living is anymore if it’s just gonna be filled with hate and stress. Death just seems so peaceful. I just want someone to care. No one understands what happened to me and the damage its done to me.

A: I’m so sorry that you have gone through such a difficult time, both physically and emotionally, but please don’t give up! I promise you that it will get better. You were at a difficult age when this happened and kids can be horribly mean and unsupportive of their peers. It may be difficult to believe now, but the older you get, the less this will matter. It sounds like this has been hard on both you and your mother, but like you said, it was an accident so please stop blaming yourself. I’m sure your mother is grateful everyday that you are still alive, and I hope that one day soon you will be too.

What you went through was traumatic and has affected your life greatly. That is why I think you should seek therapy to help you deal with it all. Talking to a professional who has training and experience in helping people through difficult life events will speed up your healing process and help you see hope in your future. Please talk to your mom soon (or your doctor or school counselor) about finding a therapist. You might benefit from a specific technique called EMDR and I’ve included the link so that you can find a trained therapist in your area. You’ve been through the worst of it already. Hang in there to see how wonderful life can be again.

All the best,

Dr. Holly Counts

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Struggling to Have a ‘Normal’ Life for Myself

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 2nd, 2021
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I’m approaching 30, and I still feel like an unsure, unstable 20-year-old! I have a lot of trauma in my past (abused and neglected as a child, bullied/ridiculed at school, and experienced abusive relationships as an adult). I’m still hurting because of my past. My life is kind of bizarre to outsider…I work in the night club industry and although I make good money for working little hours, I don’t really have a normal life. There’s very little structure to my life, I do as I please. I’m very impulsive, I eat out everyday and eat whatever I want (although I’m still in good shape). I spend money out of boredom, and buy stuff I don’t really need because it makes me feel good and gives me something to do. I feel empty and alone a lot of the time because the few friends I have either moved far away or don’t have as much free time as I do. Normal relationships are hard for me because most men cannot accept what I do for a living. I’m also not the most loyal person (I feel guilty about this) and I cannot be with someone unless I’m obsessed and I lust after them. I’m still obsessing over someone from a few years ago and holding onto any hope of a reconciliation (even though deep down I know it’s not good). I’m terrified of being in another abusive relationship with someone who will stalk me or refuse to let me go. But I’m also afraid of hurting someone or being hurt. My self esteem is not the greatest, although it’s much better than what it used to be. I’ve tried a few times to start a new career but nothing worked out, I’m not passionate about any career and I struggle to live a normal life day today. Despite all of this, people always compliment me on how “ I am, and how “normal’’ I come across. I’m excellent at making good impressions, but inside I feel empty, lost, and repressed. I have a lot of anger towards certain people from my past and certain types of people in general, but I’m very afraid to express that side of me. A lot of times I feel angry and resentful but I’ll still act nice to someone just to keep the peace…but eventually, I’ll just cut off ties with them without even officially ending our relationship. I honestly prefer things to end like that because, in my past, I’ve had my relationships end very messy! And I hate that, it gives me fear and anxiety! My question is this; I want to improve my life and become more stable but I’m unsure of where to start or what type of therapy I should receive. I think I have a mental disorder of some sort but I am unsure of which one…and I’d like to know, not to label myself, but rather to educate myself and get help. I know I cannot be diagnosed through here, but based on my descriptions, what could be some possibilities to get tested for? I’ve heard in the past Bipolar, PTSD, Borderline Personality, and even Avoidant Personality Disorder. Do any of these sound fitting in particular? Thank you in advance.

I’m struck by the fact you have highlighted your seeming failings, identified a host of possibilities about personality disorders and conditions, and point to a string of failed relationships as indicators that you are not okay. While I can understand these concerns, I am noticing that you have skipped over a wide variety of extremely positive traits that will be important if you are looking for true transformation.

First, the self that is observing aspects of your behavior that wants to change is the main element of your motivation. This self is aware that something isn’t okay and is destined to make things happen. This is the part of you that wrote this email to us in the first place. It is the one looking for answers, discovering patterns, and looking for help. This is a significant part of you, and if you are ready to make changes in your life, this is the part you want to honor.

You have also found a job you like, you are good at, are paid well for, and it leaves you free time. Most people would see this as a gift, gratitude that has been afforded you, but in your email, it is seen as something that puts you out of sync with your world. This seems more like a need for change in perception rather than condemning the situation and pointing out only the negatives.

The lack of structure and the accompanying freedom to “do as you please,” is a choice. It has suited you up until now, but, again, that part of you that is concerned and observant is realizing it is time for a change. Let’s see what is possible.

It seems like your goals have been about immediate fulfillment, which has led to indulgence. There isn’t anything bad or wrong with these decisions—and for your age, they may be just the things you needed to do. The real work and question are to ask yourself where do you want to be in 5 years. Everything you’ve described has an immediacy to it. Being impulsive, eating without concern, frivolous spending, and crash and burn relationships all point toward one thing—committing to achieve what you want. Very little in your life sounds like there was more than a short-term goal, and the emptiness you feel often follows from not stretching toward something a bit beyond our grasp.

I would use your current desire for change and irritation at your situation as the raw fuel for change. The dissatisfaction in your life is necessary for you to get motivated and change.

I would pick a reasonable goal and make micro-steps toward it. Pick something you’d like to learn more about and find a structured way to learn about it: an online class, a one-day seminar, a workshop, a course at a local university. Learning something new is one of the best ways to pull yourself out of a rut and get yourself engaged with your life.

The second thing is to do something kind for others. Find a place you can volunteer your time for a couple of hours. Helping others is a sure way to get out of your head and connected to something known to fill people up.

Of course, it is also important to look at the conditions that are holding you back,. I wasn’t suggesting you ignore them, but I am saying that not everything you are doing is bad. By clicking on the links, you can learn more about Bipolar, PTSD, Borderline Personality, and Avoidant Personality Disorder. As for therapy the kinds of approaches this one I would check out first is Dialectical Behavioral Therapy (DBT).

This is a broad-range treatment that focuses on mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation. It typically has weekly sessions in both individual and group therapy. For the issues you’ve identified, I would check out the find help tab at the top of the page for therapists or facilities in your area that practice this approach.

Finally, I’d like to come back around to your strengths, which I’ve mentioned in the beginning. Your character strengths are the way you move forward with hope and energy directed at a change in your life. I would take the character strength survey and follow the suggestions about bringing them more into your life. As you transition, you’ll want to reduce the behaviors that have been problematic while increasing the helpful ones. Learning your character strengths is the best way to balance this process going forward.

Wishing you patience and peace,
Dr. Dan

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Is My Encounter with the Psychiatrist a Red Flag?

by Dr. Marie Hartwell-Walker November 29th, 2021
written by Dr. Marie Hartwell-Walker

From the U.S.: I recently started seeing a psychiatrist for ADHD. She also offers psychotherapy and comes from an ISTDP and CBT approach. I am now on medication for that and requested therapy to help me understand and manage some of the issues my ADHD has caused. During my first 30m med management appointment yesterday, it became clear I was more depressed than I had considered myself during intake.

We ended up sort of arguing about me going on a more rigid schedule – set bedtimes, work periods, meals. I agreed multiple times that it could help and that I’d at least try, she kept trying to get me to buy into the idea with much more enthusiasm than I can honestly muster (strictly scheduled periods of my life have been some of the worst due to a non-24 sleep cycle, and I have a lot of baggage and resistance resulting from it). She kept repeating that it needs to be for me and not for her, but was more like her demanding I feel something I don’t. It had a combative feel to it, me doing nothing other than agreeing to at least try and agreeing it might help, her trying to get me to say things like yes it will help (she insisted I say yes or no, because not being sure “gives me an out” or something.) There was little effort to persuade me to see it her way, just the refusal to accept my response as acceptable.

She then said she doesn’t think psychotherapy can help me unless I’m on a schedule. It came off very much like an ultimatum, and she repeated this in reply to an email where I sent the schedule I put together. Accordingly, she has not agreed to treat me yet even though that’s one thing that appointment was supposed to address.

Unfortunately, sticking to a schedule feels like an overwhelming goal at this point, something that will take willpower I seriously don’t feel like I have available right now (e.g. forcing myself to stop what I’m doing and sleep when I’m totally wired at night due to the non-24, and having one of my main drivers for going to therapy be that it’s nearly impossible for me to begin and stay focused on my work). If I did have that willpower I might not be seeing her at all, because I could just pull myself up by bootstraps and so forth. So it just feels like she said “stop having the problems of a depressed person and I’ll treat your depression.”

Again, I’m not totally opposed to this, but I’m a bit angry about feeling browbeat into it if I want help. I have so many other things I want to work through besides depression – remember I requested help specifically for ADHD, not depression, but I also have a serious physical illness that has just worsened and am also dealing with some loss. My intake and first regular appointment have not really been long enough or open-ended enough to address any of this, and my next appt will only be a 30m med mgmt as well.

So, I don’t want to undermine this if it’s a reasonable but poorly received intervention, but now I am very hesitant to continue with her. I wonder if everything I don’t agree to immediately and with enthusiasm will result in an ultimatum, I wonder how skilled and empathetic she actually is if I come away from my second meeting with her feeling angry and doubting her skill and not wanting therapy with her anymore, I wonder if any hesitation will have her perceive me as not committed enough to work with, and I wonder if everything I’ll be asked to change is going to be something that feels like a monumental life change rather than being given the space to chip away at things in smaller, less intimidating chunks.

Does this not bode well for the therapeutic relationship? Should I look for someone else before getting too invested in this relationship? Was it reasonable to argue with me and basically turn it into an ultimatum for refusing therapy when she encountered ambivalence? It took me a long time to work up the energy to seek therapy, and the last thing I need is to spend months finding out for sure that we’re not compatible.

Thanks in advance for any thoughts or perspective you can offer.

Thank you for writing. I’m impressed that you are thinking so carefully about how to get the best treatment possible.

Without hearing from the therapist, I can’t fairly evaluate what went on between you. But what I can do is validate your experience. The most important factor in determining the success of treatment is the connection of trust between the patient and the therapist. Therapy is difficult. You need to feel that the person who is caring for you is in your corner if you are to take the personal risks that come with self-disclosure and efforts to make fundamental changes.

You don’t feel that connection with this provider. The help she is offering doesn’t feel helpful to you at this point. That doesn’t necessarily mean that either of you did anything wrong. It does mean that it may not be a “match.”

I therefore encourage you to interview another therapist or two or three until you find someone who inspires your trust and who offers a plan that you feel you can manage.

If, after seeing several therapists, you still feel that you haven’t found the right “fit”, it may be that you are expecting too much or expecting the wrong things. That then becomes something to honestly explore. But people usually find a professional they feel is right for them within the first few interviews.

I wish you well.
Dr. Marie

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