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Depression

Boyfriend has lied once, maybe twice, three times at most

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP December 10th, 2019
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

My boyfriend and I have been seeing each other for six months. We are exclusive with one another. We live 150 miles away from each other and see each other for about one weekend a month. We talk on the telephone almost every day. Two months into the relationship, he lied to me about going to an event (who he went with, supposedly ‘a friend that is a girl’). He told me it was his sister he went with. I found out a few weeks later by accident and accepted this because the relationship was new and he has independence issues. Everything seemed to be going well until this past weekend. He called and said he had to go to a work event, but didn’t want to. He texted me from there. He texted me a couple hours later to say he was home. I asked him to call me before bedtime to say good night. He did at 1 am, but I heard him shut his car door as we were on the phone and his house alarm go off when he opened another door. I did not confront; I was just normal and said good night. He has been distant ever since. He has been busy with work this week I know, but I don’t feel right somehow. I try to believe the best scenario, but I keep going back to the bad scenario since this time is so similar (what he said, how he acted) to the prior lying episode. Do I ask him outright? Am I being untrustful? I do have trust issues related to a 14-year marriage in which there was no trust. I just don’t know what to do, but I feel very upset inside.

You must take what you learned in your 14-year relationship and put it to use. The lesson from your marriage is to deal with things sooner rather than later. The chances are good that you have chosen someone who is better than your ex, but who will also challenge you with the same issue of being untrustworthy. Regardless of what he may or may not be doing, your emotional wellbeing is at stake if you do not speak up. You are not whole if you are biting your tongue. Suspicion and mistrust are likely to dominate your thoughts as you try to move forward in the relationship. The nagging sense that you can’t trust him will linger. In other words, you would be lying to yourself about how you really feel.

Use facts and be direct with him about what you are experiencing. Rather than being accusatory, speak about what is not okay for you. It would be a description of your experience communicated for the purpose of you having a voice and informing him of your reactions. He may get angry, he may be surprised, he may be glad you spoke up. Whatever he does there are two things that are very important for you both: you need to say it, and he needs to hear it.

“I” statements, talking about your feelings and reactions, work best. You are the world’s best expert on your feelings and the work here is on finding the courage to express them. What you could say might sound something like this:

I had a very uncomfortable reaction the other night when we spoke because you texted me to say that you were home, but then later called and I could hear that you were getting out of your car and going into your home. It makes me feel like I can’t trust you to be honest with me. I have already had to confront you about not telling the truth and this causes me concern about being lied to and our future.

As strange as it might sound, this isn’t about trying to change his behavior. That may or may not happen. What it is about is learning from your marriage that you have to be clear about what isn’t okay and what you are willing to accept. If you don’t say something about your concerns it gives him tacit approval to treat you in a way you find disrespectful. Not calling him on it gives him permission to continue.

My experience has been that similar issues will emerge in relationships after a breakup, particularly after a long-term relationship. If you note the problem early and express it directly there is a much better chance the other person gets the memo on what is and isn’t acceptable. I would rather see you lose a 6-month relationship than sign up for another 14 years with the same issue at the core.

If you do end the relationship you will be more prepared for the next. The man you want to be with is someone who doesn’t make you feel betrayed.

Wishing you patience and peace,
Dr. Dan

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Close To My Breaking Point

by Kristina Randle, Ph.D., LCSW July 25th, 2019
written by Kristina Randle, Ph.D., LCSW

Hello my name is Rikki and I’m 14 years old. I’m really not sure what to write in this whole thing and its kind of hard to pick a point at where to start, but I’ll try my best.

I’m not the type to open up to people unless I know they will listen and won’t act like they don’t care. I’m usually the one to try to help everyone else and be there for everyone. Since I hate to tell my problems to people since I only feel I’m being a burden.

I grew up without a father and my one brother was very verbally and psychically abuse. He even ended up breaking my finger when I was eight and would use to take a knife out and tell me we was going to kill me. What hurts the most is just having my mother doing nothing and acting like everything is okay and normal.
I switched schools in October and its a cyber/charter school. This was the third year in a row where I went yet again to a new school. When 2010 started I ended up being in a middle of a all out war at my school who were against people and I had friends of both sides of the fight. This lasted up even until now. Where all it is people talking behind your back and trust being tested for friendships and all the friendships there are pretty much fake in my eyes.

As the beginning of 2009 I started having all these health problems and going to the doctors many times to tell you this or that and that I’m going to be okay. Over a year later my syndromes have gotten worse and yet my mother still acts that I’m fine. It seems like she in denial about that there is nothing wrong with me and she wants me to be perfectly healthy.

Now down to the many mental problems I may or may not have. I have tried to kill myself about two times already from a overdose on pills. Now I keep having these sudden urges of being getting angry at people for the littlest of things and just having to grab a knife or something and want to kill them. Of course my emotions are like a roller coaster and I have suicidal thought almost everyday and now there getting to the point where there becoming unbearable. I so see and hear things that aren’t there and yes I do have voices in my head sometimes either telling me to calm down or just to let loose in some way I guess. Also that there are all these different personalities to me and they come out at different times. It’s just my mind is a mess and I want it to turn it off sometimes from the overwhelming thoughts.
I have been to a therapist before about coming up in a few weeks a year. I only saw her for about three months before dropping her. I felt like I couldn’t tell my real problems to her and would just say the ones that were a problem or just a small problem. Each week I would tell her again and to me it felt like she was just hearing the same old stuff again and again. Then we got to the topic of my mother and how we always fight all the time. She became almost rude at that point and to me making me seem as if I was selfish by saying stuff like “Have you ever thought about your mother might be going through her own depression.” and “Give her a break.” I felt like she was making me sound like I was selfish because I am in a very vulnerable place and I’m super sensitive because I hate to show weakness to people and only show it to a few I feel at home with. Maybe I’m not tough enough to take to truth or whatever, but I feel that I really want is love and yet all I get is this form of hate in different ways.

Plus I’m growing apart with my friends at my old school and I pretty much have no friends at this point and I have no one to turn to. So thanks making the time to read this sob story and have a wonderful way.

Hello Rikki. I am sorry that you are experiencing so much distress. I believe you made the correct choice by writing a letter about your concerns.

My main concern about your situation is that you feel out of control. You have frightening thoughts about harming yourself and others. As time progresses, you feel less and less certain about your ability to control your actions. If you truly believe that you might harm yourself or someone else then you should immediately go to the hospital for an evaluation. The hospital can keep you safe. They can stabilize your symptoms and offer you treatment.

With regard to therapy, you tried it but it was unsuccessful. You and your therapist did not get along. You also did not trust her. These types of problems make it difficult for therapy to be successful.

I would strongly recommend finding another therapist. The best way to do this is to call at least five to 10 therapists and interview them over the phone. Ask them many questions such as: Can they help you? How? What would they suggest that you do? Would they be willing to see you and if so, how soon? Choose the therapist who makes you feel the most comfortable. Perhaps you could find a trusted adult to help you with this. It might feel a little overwhelming for you.

I would also recommend occasionally inviting your mother into your therapy sessions. It would be best if she had her own therapist but perhaps she could attend your appointments once a month for a family session. Her involvement is important because many of your problems involve your mother. You feel ignored by her, and so forth. Part of the problem may be miscommunication. Your mother may not know or understand how you feel and the same may be true for you. You or she may not be “on the same page.” You would be surprised at how many relationship problems are caused by simple miscommunication.

Life is difficult for you at this time but it can improve. Therapy is a good place to start. Finding a good therapist could make a major difference in your life. I hope you will not abandon the idea of therapy and are open to trying it again with a new therapist. I believe this is the best way to approach your problem. Here is a link to a directory where you can search for a therapist in your community. I wish you well. Take care. Thank you for your question.

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Dealing with Depression: 7 habits of highly corrective people.

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP November 3rd, 2019
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I have had depression (off and on) for as long as I can remember but have recently started treatment for it (three years now). The treatment is really helping and I know I am making progress because of it. My depression has manifested itself as fatigue, low-motivation, low self-esteem and a disinterest in things outside the house. I may also be a perfectionist, but I haven’t really looked at that one yet. I have an undergraduate degree and graduated with honors. I just feel as thought my connection to all things work-related is simply missing. I know that this is due to my depression. And while I feel myself coming out of my depression, I also feel frustrated that my interest in things has not followed. I know I need to take baby steps in order to “get back into the world” but do you have any suggestions as to what this looks like? I have considered speaking with a career counselor but I am a bit nervous that it will leave me feeling totally overwhelmed and ready to retreat back into my shell again. (The last time I met with a career counselor I ended up crying uncontrollably in her office). I feel sad for the time I have wasted with this affliction, disgruntled about how depression has stripped me of my ability to “tackle” the work world and unsure of how to proceed in this new tentative period of healing. Thank You.

“If I had not been already been meditating, I would certainly have had to start. I’ve treated my own depression for many years with exercise and meditation, and I’ve found that to be a tremendous help. ” –Judy Collins

I am sorry your depression is so weighty, but admire the strength and resilience you are showing by combating it in therapy. Depression that has a centrifugal nature to it needs to be addressed at many levels. The fact that you are in individual therapy is excellent. Here are 7 other features you may want to consider:

  1. When a depression is so pervasive we need an equally robust offense on the thought process. What I am recommending is a daily dose of strategies from positive psychology specifically 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. Here is a link to a series of articles looking at the direct application of techniques from the sub-field of positive psychology.

    Think of it as an ongoing process as we do with physical hygiene. You may have taken a terrific shower on Monday, but by Wednesday you will need another. It is the same with positive mental hygiene. We need to generate a critical mass of positive thoughts on a regular basis. One of these articles will highlight the fact that it takes three positive thoughts to overcome every negative one, thus the need for daily strategies.

  2. I did not read that you are taking an antidepressant. I would definitely consider this if you haven’t as the research demonstrates quite clearly that the strongest combination is that of therapy and an antidepressant in the approach to coping with depression. With the new medicines being introduced there may be one that suits you.
  3. If you do not want to take an antidepressant there are several homeopathic or herbal alternatives that may be helpful. For these you will want to consult a registered dietitian. Many of the better health food stores have either access to a RD or make available such information. There is some interesting research by the federal Department of Health and Human Services on a supplement known as SAM-E. But please be sure to consult someone knowledgeable in these matters. There may be contraindications if you are taking antidepressants already (or other kinds of medicine) or have certain medical conditions.
  4. 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.
  5. Meditate. Learning how to self-soothe your emotional turmoil is perhaps the most important skill you can learn. There are dozens of meditation practices and you may have to experiment with several before you find one that you like. Here is a link on meditation to give you a starting point.
  6. Aerobic exercise. The value of exercise in combating depression is very well documented and this is particularly true for any exercise involving aerobic displacement. If you are okay to do this medically, exercise in any form will help.
  7. Review your diet. No one gets depressed, puts the back of their hand to their head and says: “ I am so depressed, I need to have a piece of lettuce.” Our emotional life often changes our craving for various foods, which may not have the best impact on our biochemistry. Again, I would check in with a registered dietitian to be certain your diet is supporting your mental well-being.

Even if you can’t implement all of these things, pick one that isn’t part of your approach right now and begin there. Depression is a formidable foe, but developing these habits for dealing with the symptoms can make the difference.

Wishing you patience and peace,
Dr. Dan

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Teen daughter out of control

by Dr. Marie Hartwell-Walker December 25th, 2019
written by Dr. Marie Hartwell-Walker

I have a 16 year old daughter that is having several issues. Recently her mother decided she no longer needed to attend school as she wasn’t passing her class. Her mother informed the school that she would no longer be attending.My 16 year old smokes pot in her room, has male friends over with the door closed and I have suspicions she is having intercourse in her room with her boyfriend. Her curfew is non-existent.

When I try to control the situation I am told that she is just being a teenager and that I need to back off. Once I was away on a trip and my daughter had a party and the police were called to the home. I did not find out until 3 weeks after my trip and I had to hear in from my neighbor. When I did find out I was furious. I did yell and I grounded her but when I did my 23 year old daughter threw me into a computer desk and slapped me in my face. My wife then told me to leave and that she was divorcing me. One other time my 16 year old pushed me down a flight of stairs when I tried to get escort her friends out of the home. That resulted in the threat of divorce once again. But when I refuse to come home my wife threatens suicide.I can’t win for losing here…

My 23 year old lets my 16 year olds boyfriend live at her apartment because he ran away but the kicker is his mom doesn’t care. They tried getting me to allow him to live at our home. So far I have been successful in stopping that from happening but that has driven a wedge further in to the family.

My clothes have been thrown out into the snow and I was told that if I don’t stop yelling I was going to be “taken care of.”

Now, I have talked nice, setup family meetings to go over rules and asked that we all go see someone. They all tell me that I need to just back off and let my 16 year old grow up. Their main problem with me is that I yell about these issues after asking nicely over and over and asking for them to cooperate. I do get very angry but I have never once been physical.

I make a good living but my wife makes sure she transfers my pay into a different account each payday. If I do leave she threatens suicide and my daughters call and text me that they will make my life miserable if I don’t go home to their mother. In other words they will make trouble for me at my place of employment.

Lately I have been feeling paranoid at home when I go to sleep. Leaving aside the doors opening and closing at all hours of the night which really freaks me out, and I know this sounds stupid but maybe my mental state and lack of sleep are getting to me. I just feel threatened all the time but even more so when I go to sleep. Every little noise makes me jump. I feel like I am going to be attacked when I sleep.

I have tried to bend to their way of thinking and how they live life but I just can’t get my mind to go there. I refuse to live in a lawless home with no moral compass but I am trapped by threats of violence, suicide and lack of access to funds.

I have told my wife we are critical and we need serious help but she refuses. I really have no options in this situation. My job is the only thing keeping me sane and if I try and leave my home my job is in jeopardy. I feel like disappearing without a trace is my only option.

You are living in an atmosphere of domestic violence. If the genders were reversed and you were the woman in the situation, help would be more readily available. But violence is violence. You are being physically and emotionally abused. Your wife isn’t partnering with you to raise your daughters. Your daughters have assaulted you. And your wife uses emotional blackmail by threatening suicide to control you. It sounds like you are being bullied by all three women and only valued for your paycheck. It’s no wonder you’re feeling beaten down.

I’m sure the situation is more complicated than you could fully describe in a letter. There may be good reasons why you are convinced you can’t do anything. But I do have a few suggestions for you to consider.
First, if your workplace has an “employee assistance program” (EAP) , you could access some confidential help there. EAP counselors can make some practical suggestions and can refer you to a mental health professional and to a lawyer. I think you need both:

  • You were absolutely correct to suggest to your family that you all need help. But since they won’t go, go yourself. A counselor will help you regain your emotional strength, will give you much needed support, and may well have some ideas for how to bring your family into treatment. If your company doesn’t have an EAP to help you locate a therapist, ask your doctor for a referral.
  • I suggest a lawyer because I think you need to find out what your rights are regarding protection from violence and threats, as well as your rights regarding how your pay is used. There may be a way for you to protect some of your money. If you had a bank account of your own, you wouldn’t feel quite so trapped.

You made an important first step in writing to us at Psych Central. Please now follow through and get the help you need. No one deserves this kind of treatment (even people who yell). You need to extricate yourself from this situation both for your own sake and for the sake of your daughters. This is not a healthy way for anyone to live and it certainly isn’t a positive model for how family life should be.

I wish you well.
Dr. Marie

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Please Help. I Am Lost

by Kristina Randle, Ph.D., LCSW October 29th, 2019
written by Kristina Randle, Ph.D., LCSW

I think that I may have depression and/or skitzophrenia. I am lonely all the time and I feel like no one really cares about me. I get upset really easily and tend to overreact. I am friends with a lot of people but am not really close to any one person. I hardly ever get invited to any social events like sweet 16s because even though I am friends with a lot of people, no one really likes to include me like that. My friends often talk about their plans infront of me without including me. This really puts a damper on my self-esteem. I don’t understand why they never want to include me. Maybe it is because of my mood swings. I’m known for getting real angry, real fast. I think about killing myself sometimes, but I think about how it would hurt my dad. He would be all alone (my mom cheated on him with a close family friend a year and a half ago) and my brother is in college…I got skin cancer on my foot in the same year that my mom cheated on my dad. It was a bad year for me. Sometimes I think my friends forget how hard my life is. They all talk about their petty problems and it gets on my nerves. I often change myself for the group of people I am around. I curse more and talk louder with one group, act more mellow with another, and just plain crazy with the other. I don’t like dissapointing people. I actually FEAR disapointing my familly. I have lost interest in one of my previously favorite sports, softball and have noticed a steep decline in my school work. I lie to my teachers like a professional, making up excuses for missed work. I feel that (compared to my friends) I am the fattest and uggliest of the bunch. I also feel that even though I do favors for everybody else, no one seems to want to reciprocate. I’m always tired and watch TV like my life depends on it. I sometimes think about running away and just doing all the things that I want to do, not what society wants to do. But I would never be able to support myself, so I just go with the flow. Basically, I feel like I’m a lost puppy who just doesn’t belong anywhere and that no one cares about me. Because I change so much for other poeple, I don’t know who I am anymore.

I cannot know with certainty but I do not believe you have schizophrenia. Perhaps you have an adjustment disorder. An adjustment disorder is a strong reaction to life stressors. Your current life stressors include problems with school, peers, and family issues. You may also be experiencing depression. As you have noted, some of the activities that you were once interested in no longer bring you pleasure.

It is important to keep in mind that I cannot officially diagnose you over the Internet. These are my impressions based on a short letter and they should not take the place of an in-person mental health evaluation.

You need guidance. It does not seem that you have anyone you could go to for advice. What about your parents? Can you speak to them about how you are feeling? Would they be able to advise you regarding your relationship problems with peers? If not your parents, then what about a school counselor? The school counselor may be able to teach you a better way of interacting with your peers.

When you report that you “go along with the flow” and “change for other people” it tells me that you may be experiencing problems with self-esteem. Individuals will engage in that type of behavior usually because they desperately want to be liked. They think that if they do what their friends want them to do, they will like them. As you are learning, that strategy doesn’t work. What usually happens is that your peers will take advantage of you. By learning better social interaction skills and ways to improve your self-esteem you can change the response you get from your peers. Those skills can be learned in therapy. That is why you should consider seeing a school counselor. If a school counselor is not available to you then you may want to ask your parents about seeing a mental health professional.

The good news is that the problems you are experiencing are relatively common and can be dealt with in a counseling setting. Please consider the school counselor and talking to your parents. They may have good advice for you about how to better handle peer situations and your parents may also be willing to send you to a therapist. I hope I have answered your questions and given you hope and assurance. Thank you for your question. I wish you well.

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Feeling Different From Everyone Else

by Kristina Randle, Ph.D., LCSW May 19th, 2019
written by Kristina Randle, Ph.D., LCSW

My name is Rachel and I am 15 years old. From the time i was born until i was about 6 I had watched my father beat my mom every day and my dad would smoke crack and pot while i sat on his lap. My mother and father got divorced when i was about 6. My mom used to and still sort of is an alcoholic; but she has slowed down very much. I used to wake up in the morning and find a different guy in my moms bed every day. My father has verbally abused me since i was just a child and that has made me feel worthless as a person.

Since i was 12 years old i have been harming myself; cutting burning etc. when i was 13 I tried to actually kill myself and took 2 bottles of pills. I have been failing all my classes in school since 5th grade; I got held back in the 8th grade. And i’ve always had a problem fitting in with people. I started drinking alcohol when i was 11 years old and continued to drink almost every other day until i was about 14. I started smoking marijuana when i was 14 and shortly after began smoking with my father and that made me feel extremly weird about the situation. I stopped seeing him about a year ago because eventually it all became to much for me to handle.

In january of 2007 I lost my virginity to a boy who i didnt even know and i dont remember anything about it; all i know was that he was 24! I felt extremly depressed after that. I started taking prescription drugs about a year ago (mostly opiates) and that slowly led to heavier drugs like heroin. I am an addict and I have been attending NA meetings because i am trying to get my life back in order, I recently slept with a boy for drugs because i was craving so bad.
I guess what i am trying to say is that; since i was a girl nothing has been good and i feel like things are always going to be this way.

i am already diagnosed with severe depression and anxiety disorder but i feel like there must be something else wrong with me. As strange as this sounds i have a hard time talking to people about my problems because i think that they are going to think that i am saying everything for attention. and that is a massive worry of mine. I have terrible self esteem and i do not like one thing about myself. I also have these really strange moments during the day that i will go from extremly happy and random for a few hours and than suddenly extremly depressed to the point where i dont like to tlk to anyone. There is alot more i could say but im hoping this will be enough.

I just want to know if anyone can tell me if i could have some kind of other disorder besides just depression and anxiety.. because i dont know anyone who is like me and i really am tired of feeling like this. Thanks. Rachel

Hi Rachel. From my perspective, you are a victim of circumstance. You were raised in an environment in which you were not protected, you were abused and drug use was encouraged. What happened to you was neither fair nor was it your fault. You witnessed your parents use drugs. Unfortunately it’s not surprising that you ultimately ended up using drugs yourself.

People need positive role models, especially during the early, formative years. They need people to show them their way in life. They need guidance. You did not have that luxury. Your parents did not take care of you. They left you to fend for yourself, perhaps because they had their own issues to deal with.

Understandably you have severe depression and anxiety. There may be other disorders that you could be diagnosed with but if other diagnoses were identified I’m not certain how that information would help you. It might help a doctor because he or she may know of a treatment that may benefit you but I fail to see how your knowing of other diagnoses would benefit you. Treatment in the form of counseling and possibly medication would be the most beneficial to you.

If you’re not already in counseling please ask either your parents or other adults in your life to get you involved. The issues you are struggling with can be overcome but it’s going to take time and the assistance of competent mental health professionals.

I’m very encouraged to learn that you are attending NA meetings. Many people believe that NA meetings and the people associated with them have helped to save their lives. It will take time to correct the damage from your childhood but it is doable. Your life can be better. Be patient, attend counseling sessions and NA meetings. Thank you for your question. I wish you the best luck. Please feel free to write back with followup questions.

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What’s The Point Of Life Anymore?

by Kristina Randle, Ph.D., LCSW July 5th, 2019
written by Kristina Randle, Ph.D., LCSW

Ok…its a lon gone and hard to explain. My mother has just recently decided that we need to move four hours away from the town we live in now. Just recently a girl I’ve known an dated on and off for eight years told me she loved me. I have extremely strong feelings for her, and I think I might love her too. ONE PROBLEM- in about 6 months I’m going to be long gone and living in some po dunk town four hours away from here. I might not ever get to see her again! On top of the rest of this, my step dad and grandpa died about 6 months ago. Since then my life has gone completely downhill. I know I won’t ever get to see her again if I move and I can’t stay. It’s like I’m anchored in one place but and irrisistable force is forcing me in a different direction. It feels like someone is twisting my heart around with a piece of sharp ice. No matter what I do my life just gets worse, and worse, and worse!

The worst though is that I found out that last year when my mom put me on homebound and she didn’t see me for months, she tried to slit her wrists. So if I leave she might do something stupid…especially if she’d never see me again. I wouldn’t even have a way of contacting her. On top of losing all that Im losing by moving, I’m moving to a new town and going to a new school- we all know what happens to the new kid in high school. I just don’t know what the hell to do or why I should live anymore, why I shouldn;t just off myself. I just cant take any more stress or heartache or I might do something stupid because I dont know how to deal with this.

I understand that you are experiencing a great deal of stress. Nothing in life seems to be going your way. Please understand that life has its ups and downs. At this point in time you are experiencing several unfortunate and unpleasant situations. Yes, it is undoubtedly a difficult time for you but it is important that you realize that your situation will likely improve. You’re assuming, for instance, that you’re not going to like moving. Assumptions don’t always turn out to be true. The truth is that there’s no way to know if you will like or dislike your new town or school. Yes, there are some individuals who when they move have a difficult time adjusting, but you may surprise yourself and like it. Your move may not be as negative as you are predicting it will be. My advice for you regarding this matter is to stop assuming the worst outcome and to keep an open mind.

As for the girl that you like, there is no denying the fact that leaving her may be difficult. It will likely not only be difficult for you but as you mentioned it may be very upsetting to her, to the point where she might harm herself. Given the situation, it is advisable that you do one or all of the following: speak to your mother, her parents, or consult the school guidance counselor about your concerns regarding your girlfriend. The fact that she may harm herself is a very serious concern and not something you should be dealing with on your own. Perhaps if you and she had a constructive way to deal with the inevitable move, then it could help ease the transition for you both. I hope you will strongly consider informing an adult about the fact that she may harm herself.

I am also very concerned about the fact that you are considering suicide. As mentioned above, life has many ups and downs. It will not always go smoothly. That is the case for everyone. You need a better stress management strategy in place for when life gets tough. You may be considering suicide because you’re not sure how to handle difficult life circumstances. Please know that you can learn alternative methods for handling stress that do not involve harming yourself or ending your life. You can do this through counseling which has been shown to be very effective for many people. Millions of people are helped by counseling. If you’re not sure how to access counseling, then you should speak to your mother about how your feeling or go to a school counselor immediately. If you feel that you cannot keep yourself safe, then you should go to the emergency room and inform them about your plans for suicide.

Your life is likely going to change upon moving but don’t assume that there is going to be a negative outcome. It may turn out to be the best move of your life. The point is you don’t know what the outcome will be and you should not make assumptions. The smartest thing you can do now, as a mentioned above, is to speak to your parents or a school guidance counselor.

If you’re suicidal then call emergency services or go to the emergency room immediately. It’s also important that you have in your possession a number to a suicide hotline. Please call 800-273-8255 in the event that you feel overwhelmed. This is the number for the National Suicide Prevention Lifeline which is a 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis. Thank you for your question.

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Chance of Relapse?

by Kristina Randle, Ph.D., LCSW May 11th, 2019
written by Kristina Randle, Ph.D., LCSW

Have you ever been so afraid of being attacked or hurt that you would try to stay on guard constantly? If you asked me this question about a year ago, I would answer yes. Why did I feel like this? I am still wanting to find out. I will find out in the future.

I was born the youngest of 4 in a small town in the middle of nowhere, West Virginia. I never felt like I was home there. I wanted to live in cities like Los Angeles, CA or Seattle, WA or some city like that. I wanted to live in a big city. I was a product of a high risk pregnancy and I had motor difficulties in my early childhood. The doctors thought I was Autistic, yet they never fully diagnosed me with it. I can’t remember anything before I was 8, which I think may be unusual? I do remember what my mother told me.

In my freshman year of high school, I started experiencing extreme crying fits and cutting episodes, along with hallucinations, which would make me scream into nothingness. I feel like without them I would be lonely, so I never told anyone, not wanting them to leave. Even though, they were upsetting me and blatantly insulting me every minute of every hour of every day of every week and of every year. I would cut just to appease them, they seemed to want me to harm myself. I wanted them to be happy. I want everyone to be happy, no matter what I have to do to appease someone, I will do it. It continued into my Sophomore year, then my mother noticed the scars and forced me to go to the psychologist. After seeing me for a while, they diagnosed me with Major Depressive Disorder with Psychotic Features. I was put on Prozac and Risperidal. It was all well, until my Junior year. I thought I was better, so I quit the medicine. Needless to say, the voices continued again. I started cutting more than I ever had and eventually cut a vein and ended up the next day in the hospital. they sent me to a hospital in Pennsylvania and I stayed there for a while.

I am now a Freshman in College and a pre-law major. I want to know if there is a possibility that I might go into this again? And if it will be worse, if it does? Is it possible that it could be worse than Psychotic Depression, like Schizophrenia, Schizotypal, or Schizoid Personality? Is it even possible to fully recover from this disorder, without any relapses?

There are several things I wish to address in this answer. One is the idea that you have been diagnosed with major depressive disorder (MDD) with psychotic features. This disorder is very similar to other disorders such as schizophrenia and in particular, schizoaffective disorder. There are some people diagnosed with MDD with psychotic features who might have been diagnosed with schizophrenia or schizoaffective disorder by any number of other mental health professionals. The abovementioned disorders are similar and it’s not usual for an individual to be diagnosed with MDD with psychotic features and then later diagnosed with one of the other disorders. The possibility exists that you were misdiagnosed and perhaps have schizophrenia or schizoaffective disorder. I’m not saying that you were in fact misdiagnosed; I’m simply saying that it is a possibility.

Another aspect of your question I wish to address is that at some point you were taking medication but you stopped because you felt better. This is very common. Individuals often mistakenly believe that because their symptoms have improved they no longer need medication. What they fail to realize is that it is the medication that accounts for symptom improvement. Stopping the medication abruptly may induce a relapse. If you want to prevent a relapse then it is important to stay in treatment and to take the medication consistently.

I understand you may not like the medication and it may have side effects that are unpleasant. No one wants to take a medication that makes them feel unpleasant, tired or sick, and so forth. It’s worse, however, to risk the return of symptoms such as hearing the voices or having a psychotic episode. Psychotic episodes may lead you to engage in behavior that is dangerous to yourself or others and possible future hospitalizations.

If you want to stop the medication then you should do so with the assistance of a doctor. He or she can slowly reduce the medication dosage over time. This process is called titration. It is one way to prevent a relapse. It can significantly reduce the likelihood of a relapse which can be caused by suddenly stopping a medication. Relapses are more likely to occur when an individual abruptly stops the medication versus slowly reducing the dose. This is an important point to remember.

In addition, there is some evidence that psychotic episodes cause brain damage. Each psychotic episode may lead to actual damage to the brain. This means that with each psychotic episode, it may be more difficult to return to your previous state of functioning. This is known as stepwise decompensation. It is important to prevent psychotic episodes when possible. As I mentioned above, I understand that you may not want to take medication, but it may be better than risking a relapse and damage to your brain.

In your specific situation you are attempting to complete college. The best way to handle this situation is to be in contact or in treatment with a mental health professional and to stay on a medication if you have been prescribed one. Generally, among individuals with psychotic disorders, this is the most effective way to prevent a future relapse.

It’s also important to you keep your stress levels low. High stress has been linked to an increase in psychotic episodes. A mental health professional can help you learn strategies to deal with stressful circumstances when they arise.

MDD with psychotic features, schizophrenia, schizoaffective disorder and other related psychotic disorders may not be curable but they are manageable, if you’re willing to abide by the advice of your treating mental health professionals. Thank you for your question.

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Body Dysmorphic Disorder is making her miserable

by Dr. Marie Hartwell-Walker December 16th, 2019
written by Dr. Marie Hartwell-Walker

I’m 22 now. When I was younger I was very overweight, I topped out at 160lbs at around 5ft 3in when I was in middle school. Everyone always made fun of me for being so fat, but at the time, although it hurt, it didn’t really seem to affect me so much. However, towards the end of middle school I became obsessive about my weight and weened myself down to eating barely anything. Over 200 calories was deemed unacceptable to me, and I dropped down to 120lbs and was now 5ft 8in. I still was absolutely disgusted with myself and wanted to be as skinny as possible, so much so that I envied those who were labeled anorexic. I even joined a pro-ana website.

Eventually, I started eating a little bit more, but i would force myself to puke it up. I always felt disgusting and fat. I hated myself so much that I resorted to self mutilation.At this point my parents finally got worried and I was put on antidepressants and taken to a therapist. I stopped taking the medication and only went to about 3 or 4 sessions with my therapist because we couldn’t afford it and I hated it anyways. Again, I eventually started eating more, but now I’d only eat “fat free” food, and I’d still purge. For the sake of my parents, I forced myself to stop purging because they knew I was doing it. It was hard to not recognize the smell of puke lingering in bags in my closet, and stuck in the drains in the bathroom. It was hard to stop but I did it. In the process, I joined a gym with my mom and I became obsessed with working out. I worked out at least 2 hours a day 5 days a week. I still hated my body though. I started training with a trainer to lose more weight though he said I was already skinny, I wasn’t to myself and that’s all I wanted. Unfortunately with the diet plan he gave me I gained 10 lbs which was supposedly from muscle, but to me, 10lbs was 10 lbs. I finally got fed up with it all and had liposuction at 19 years old. I was convinced it’d make me happy, but $9000 later I hated myself even more. Now I swear it was a botched liposuction and hate how uneven it is and the bumps it left on my stomach and how it messed up the shape of my butt. Needless to say, I am now 22 and I hate my body more than ever. I hate my bumpy stomach, my rippled jiggly thighs, my flapping arms. I hate the size and shape of my butt and breasts, I hate my fat wrists, I hate my nose, the size of my eyes and lips, the shape of my face, and the length of my toes. I don’t think there’s anything I don’t hate at this point. I have MANY crippling issues but this is by far the worst of them. I cry all the time even though my boyfriend always says I’m skinny and beautiful. Everyday is torture to me, its all i think about and it consumes my whole life and all of my energy. I spend my days wishing I was other girls and feeling like I’m nothing. I’ve been suicidal many times, and though I don’t believe I would ever try it, I can’t say I don’t ever think about it anymore. Noone even knows any of this other than my boyfriend. I guess the front I put up is so good that everyone thinks I grew out of it, and my god I wish that were the case! I am now eating somewhat normally, almost compulsively actually and I absolutely hate myself for it. I am 155lbs and still 5 foot 8 which is supposedly healthy but I feel like a blimp and can’t stand to even look in a mirror. I still have feelings of wanting to stop eating or to purge. I just don’t know what to do, and why this is happening to me!!I hate my life so much because of this. I don’t know if it has anything to do with this, but even when I was around 130 lbs my mom always had comments about my weight and told me I couldn’t fit into the clothes I wanted to wear. If I picked up a small, she’s pick up a large. She always made comments about my body like my but being flat or my toes being freakish or my top lip being smaller than my bottom one, and many others. She makes comments about what I eat..even the rice cakes, she says I need to watch what I eat. A few years ago my brother also admitted he said he didn’t love me when I was fat, and he laughed like it was a joke. It hurt…ALOT. Especially because it was coming from my older brother who I always looked up to. He even has his own issues with his weight, he too was very overweight and crash dieted when he was in high school.I just don’t know what to do with myself, I feel beyond help.

I’m very, very glad you wrote. You’ve been in pain around body issues much, much too long. Yes, it makes sense that family members’ comments would make you feel self-conscious. And middle school is traumatizing for many people. It sounds to me like maybe you developed what’s called body dysmorphic disorder in response to all that negativity. You have an unrealistic idea of what your body looks like and it’s been making you miserable.

It’s time for you to have what I call a healthy rebellion. You’ve apparently taken old messages from middle school and family members to heart and accepted those opinions as your own. It’s time to reject those ideas and to decide for yourself what is good for you. My guess is that those same individuals have been wrong about many things. Why would you think they were right about what you look like?

Yes, I know. A healthy rebellion may sound good to you but feel too hard to do on your own. In that case, having the support of a sympathetic and experienced therapist would probably give you quite a bit of relief.

I’m sorry your first experience with a therapist didn’t work out. But maybe you didn’t have the right therapist for you. Ask people you trust to recommend someone and look for a therapist you feel you can work with. Research has shown that cognitive-behavioral therapy is probably the most helpful for this problem so look for a therapist who has that training.

You are most certainly not beyond help. But you have to accept some help to get it. You made an important first step by writing. I hope you will take the next step and give therapy another chance.

I wish you well.
Dr. Marie

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Depression and the Asian Culture

by Kristina Randle, Ph.D., LCSW September 16th, 2019
written by Kristina Randle, Ph.D., LCSW

Hi, I’m sixteen years old and living as an expatriate in Hong Kong Ever since I was about 12, I’ve been falling in and out of phases where I’d get really down and stop eating, and used to depend my emotional well being upon a boy.

Yet now, I’m scared because I know I’m getting too sad to function, and I can’t pull myself together. I don’t have an appetite, I never do my homework anymore, I can’t even wake up in the morning and feel like socializing with my friends is impossible. Its as if I’m trying to float in the middle of the sea, when its just so much easier to sink and die. On the topic of death, I always think about how much easier it would be to die, and often feel resentment towards the fact that I’m living, though I’m rational enough not to kill myself. I cope by not eating, which is easier because I don’t have an appetite anymore. I can’t stop restricting though, even when I want to. At one point I convinced myself I didn’t actually look like a human being and therefore needed to starve myself silly and deserved to die.

My main issue is I know that I need help, but in an Asian-dominated society, in which mental health issues are taboo. I want my school to notice me, but all it’s concerned with is academic excellence. I’m too afraid to ask for help.

I think you need to know a little about me.

My 3 closest friends moved away/were sent to boarding school against their will at the end of last school year. Just my luck.

My love life is very complicated. I’m in love with two people, one who’s always been there, who I’ve always known, and knows me like my best friend. The new guy is much better for me (I know this but my heart won’t believe it) and will take care of me, and doesn’t toy with me emotionally like the old guy.

I’m also quite upset because last year my childhood best friend died and my parents stopped me from going to the funeral because of a family feud that happened a few years earlier. I have so much regret and guilt.

One last thing, though my parents can be wonderful people, when we don’t get along it is hell living at home. My authoritarian father can never be wrong and has a major temper. My mother cannot let a grudge go and when angry, will make up things and continue to yell at me for other things I have done in the past to make her arguments stronger. They call me lazy and always focus on my negatives. I cannot confide in them.

Basically, I’m really unhappy. My grades are slipping, I can’t concentrate, and I just need to know how to get my school to notice me and recommend me to see somebody. Or just know how to pull myself together, because I can’t keep being this way. Thank you.

I do not think that you should only rely on yourself to “pull [yourself] together” because as you said you can’t help how you’re feeling. I’m sure if you could change how you felt you’d do it instantly. Individuals experiencing depression can’t just “snap” out of it. It’s not that easy. Depression can be complicated. It often requires treatment from mental health professionals, usually in the form of counseling.

You mentioned that you live in a culture in which mental health issues are taboo. It is important to identify these aspects of your culture. The fact that you recognized this about your culture indicates that you’re an insightful individual who is keenly aware of your surroundings. People are not always aware of their culture.

Let’s go one step beyond awareness and examine how this cultural mindset directly impacts you. There are personal ramifications. As you noted the cultural norms in Hong Kong dictate that mental health issues are taboo. For you, this means that even though you know you’re suffering you feel that can’t ask for help. The culture indicates that asking for help would be wrong. You fear what those around you will think if they were to learn that you have depression or another related mental health issue. Instead of asking for help and receiving it you’re left to anguish over your grades, starve yourself, ruminate about death and hope that at some point in time, you’ll be able to snap yourself out of it. In essence, by not going for help you’re allowing the cultural norms of Hong Kong to dictate your behavior. Followed to its logical extreme, your culture prevents you from accessing help, you may be destined to be miserable for the rest of your life. That’s the potential outcome unless of course you’re one of the fortunate individuals who are able to “snap” themselves out of their depression. I hope you can see that this is no way to live.

Every culture has it norms and rules. But what you cannot do is to let the beliefs of culture rule your life. You should move beyond behaving in ways that society identifies as the norm. You must do what is right for you. Do what is in your best interest. Yes it’s important to follow and obey laws and to be morally responsible. But it’s not okay to delay seeking help when you’re clearly in need of it just because it’s not the expected way to behave. What this specifically means for you is that you should not wait until someone notices that you’re experiencing a serious mental health problem before you can be helped. You need to alert the proper authorities (i.e. mental health counselors or teachers within your school or your parents) as to how you are feeling. You need to do this sooner rather than later.

I realize that it’s not going to be easy to ask for help. As you described in your letter, your parents may be difficult to deal with. They may have their own idiosyncrasies. That can make your challenge doubly difficult. But I think it’s important that you find a way to access treatment despite what your parents may think. Don’t wait for someone to notice you’re suffering. Emotional pain often goes unnoticed. That’s because it’s not visible in the same way that a broken arm or a gash on the head is. You have articulated very well in your letter the issues you’re facing. Your continued, unabated emotional distress should not be an acceptable outcome. It’s time to move beyond culture and access help before your problems become overwhelming. It’s the only correct way to handle this situation. Thanks for your question.

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Normal to be Depressed 10 Years After Losing Husband?

by Kristina Randle, Ph.D., LCSW August 5th, 2019
written by Kristina Randle, Ph.D., LCSW

Q. My husband of 23 years, the love of my life, my soul mate, died July 9, 1998. I remember the Doctor in the emergency room telling me he had died. I remember going with my children into the room where he had died to say good-bye to him. I remember being very calm at the hospital. After that I don’t remember too much at all. The funeral, the graveside service, the get together afterwards, all a blur. It took me 8 months, 3 hospital visits, many different medications and 3 rounds of ECT to get me to a point where I could finally be around other people and get myself back to work. I was treated for major depression and today, nearly 10 years after his death I am still taking several antidepressants. I see my psychiatrist about every 3-4 weeks if I’m feeling okay, more if I’m not feeling okay. I see my psychologist usually once a week, sometimes I can go for two weeks but not very often. I have been doing this ever since my husband died. My hospital visits became necessary because I wanted to end my life. I still think about suicide a lot, it’s a real struggle for me, which is part of the reason for my medication and my talk therapy. For the first 4 or 5 years my son and my daughter supported the fact that I was taking medication and going for counseling. However, now its a different story. For the past 4 years it has become something we can no longer discuss without having a serious argument. They love me I know but they just cannot understand why I still need help. They have told me over and over again that no one grieves for 10 years. They want me to move on with my life, to enter into a new relationship, to find some peace and maybe even find some happiness. I want those things too, but honestly I doubt it will ever happen for me. I have talked to both my Doctors about this and they tell me everyone grieves differently. I tried to explain this to my children but all they say is that both my Doctors are taking advantage of me. They say that neither of my Doctors really care about me, that the only reason they are still seeing me is for the money. I don’t believe that for a minute. I know for a fact that on numerous occasions they have actually saved my life. If they had not been willing to talk to me, regardless of the time of day, I know I would not be here today. Now for my question. Is it unheard of for a person to be depressed for this amount of time? I hope you will be able to shed some light on this for me. Thank you!

You should love your husband forever. Your love should not lessen but remain a pure and true link between the both of you. In this way, he lives on within you.

Having said this, it is not normal for you to be so depressed after such a long period of time. If you were my client, I would look for the reasons why you are depressed and the one reason that I would rule out is the death of your husband.

If things go as nature planned, every child will experience the death of their parents and still life goes on. Many parents will experience the death of a child and their lives go on. Many spouses experience the death of their husband or wife.

It is a mistake, a terrible mistake, to assume or to think for even a moment that “you loved your husband” more than they loved their son or daughter or mother or father or husband or wife.

It is also a mistake to think that you are weaker than they are. You are no weaker, you are just less well equipped to deal with your loss and there is a reason for this. We need to find this reason and make the necessary corrections. And it is most definitely… correctable.

You appreciate your doctors and that is good. They are very well intended but the question becomes are they “very good” or even good enough to help you with this problem. They might be great with other problems but perhaps not with yours. This is a very definite possibility.

How long should you be in therapy…as long as it takes…perhaps as little as a few weeks or as much as weekly for the rest of your life. Here is the caveat, the test that should be applied. You should be making steady progress, a little better after any time period of measurement you wish to apply. How much better isn’t the issue because every person has different problems and different degrees of those problems. But over time, week by week, month by month, year by year, better and better and better.

Please let me know how you are doing and do write back if you want further clarification of my answer.

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Depressed boyfriend won’t seek help.

by Dr. Marie Hartwell-Walker November 22nd, 2019
written by Dr. Marie Hartwell-Walker

I have read a lot of advice regarding the treatment of a boyfriend suffering from covert depression. Unfortunately, none of this advice appears to pertain to my specific situation. Seeking help from a professional third-party or suggesting antidepressents is not an option for me.

My boyfriend (age 22) of seven months, whom I’m very much in love with, is depressed. This stems from a variety of issues, prodiminately, I’m assuming, his relationship with his parents, past and present. Both his parents are extreme over-workers. His mother is a clinical psychologist and tends to give him the patient treatment. His love for her seems to be simple familial duty, I don’t think he actually likes her as a person. On the other hand, he seems to greatly admire his father.

Sadly, he bears the brunt of some psychologically damaging behaviour. For example, recently he pulled up the carpet in the house that he lives in alone, but which is owned and attached to his parents’ house, to investigate a leak. He ran into his father while in his parents’ house to fetch more towels. His father demanded to know what he was doing and when he discovered that his son had pulled up the carpet, his diatribe went something along the lines of “Why would you pull up the carpet! We let you live here for free and you take it for granted and freeload! You’re selfish! You should have just asked me if you needed help!” etc.

My boyfriend is notoriously independent and didn’t want to go to his father for help. He felt blamed for something he could not control (a leak) and it’s episodes of this nature that make him want to move, not just to another house, but to another city.

On the other hand, I don’t think it’s just because of his parents that he feels that his house is not a home. He tells me he never wants to go home because it feels like “just a place where he stores his stuff” and not an actual living sactuary.

He is prone to fatigue, desire for isolation, sexual indifference and mood swings. He completely adverse to any type of professional help or medication. He is very intelligent, proud and independent to the point that he feels any assistence of this type would be useless as he feels he can deal with the problem on his own.

He does not often seek my counsel, preffering to be alone although sometimes he will confide in me, though nothing I say seems to make any difference and, often, merely irks him.
My question is, how do I deal with his depression because sometimes I wonder whether it’s his depression that causes him to be distant or whether it’s a distinterest in me. Sometimes it’s hard to bear the brunt of his illness. What can I do for him and what can he do for himself?

I’m not sure if your boyfriend is depressed or stuck in adolescence, or both. He’s 22 but he’s living in his parents’ house. He wants to be independent but he accepts a free place to live. Sorry. The two don’t go together. If he doesn’t like the situation, he should do something more than complain about it. His father certainly could have addressed him more respectfully but the fact is that his father owns the property, not your boyfriend. Your boyfriend had no business pulling up carpet (or using their towels) without asking for advice about what to do. It would be the same if he had any other landlord.

The father’s diatribe suggests impatience with the situation from his end. It seems to me that your boyfriend and his parents have some work to do to clarify what he is expected to do and when and how he plans to move out and become a fully independent adult. By being so helpful, his parents may be inadvertently making it too easy for him to stay stuck. Your boyfriend may be scared to be truly on his own. Rather than face his own fear, he blames his parents for wanting only what he wants — for him to be independent.

Meanwhile, what are you getting out of all this? Your boyfriend certainly doesn’t sound like a good bet for a mature longterm relationship, at least not yet. However charming he may be in private moments, he has a lot of growing up to do. Be careful about supporting him in his complaints about his parents. Focus instead on what he plans to do about his situation. If he is truly clinically depressed (see the symptoms in our mental health library), he needs to get over his aversion to his mother’s profession and take care of himself. If he is depressed, he would benefit from seeing a counselor and maybe taking some medicine. Part of being an adult is doing what you need to do — even if your mother might not approve.

I wish you well.
Dr. Marie

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Is it Just Depression or is it Schizophrenia?

by Kristina Randle, Ph.D., LCSW July 22nd, 2019
written by Kristina Randle, Ph.D., LCSW

Q. For the past couple of years I have been extremely down and suicidal. I went to a counselor when I was 15 for 3 months but had a very hard time opening up so ended up lying. It was a waste of time and I felt equipped to handle things by myself so I stopped going. I was okay for about a year but then things began to get progressively worse. Firstly, I started to feel very sad about my whole life and then suicidal thoughts came. There were many times where I was desperate to kill myself but didn’t as I knew how selfish it was. I overdosed on sleeping tablets but managed to sick them back up, so no real damage was done.

I have always been a closed person, so none of my friends have any idea what is on my mind. I am a very fake person and a compulsive liar (something I have been since I was young but it has become a lot worse in recent years). After that I wasn’t so upset anymore. I feel very emotionless and never cry. Yet I still do not enjoy myself ever and always feel that life is more bother than fun. I have become extremely lazy and have quit all of my hobbies. I have become reclusive and hate socialising to the point that I have panic attacks if I have to go out. I spend my time holed up inside my room (I do not live on campus at uni, i live at home with my mum).

I have been to the doctors and they said that I was quite clearly severely depressed and in need of medication. They said that I was lying to myself and that even though I said I didn’t care about my parent’s divorce or my sister’s anorexia, that they clearly had affected me. I have been referred to The Priory to see a psychiatrist and follow methods of treatment other than counseling. The problem is that I am not so sure it is just depression. I have a hard time understanding what I feel due to my compulsive lying and my grip on reality is not too strong. I have times where I am not sure if I am making up memories in my mind or if they really happened. For example; I told my mum that I had been hearing voices but then I doubted myself and could not remember if I had or not.

I am a very angry person and dislike most of my friends. I have self harmed badly in the past and am becoming more and more aggressive. I am constantly restraining myself from hurting other people and my mind keeps telling me to hurt people — I am not hearing voices or having any hallucinations though. I am certain that there is some sort of poison or evil inside me that is rotting me away and controlling what I think. I know I am not as evil as my thoughts are, so something must be making me think like this. I don’t like society and know I won’t be able to cope living in it much longer. I want to be completely isolated but i know this is not possible. I am not hallucinating or paranoid but I do sometimes get the feeling that someone is with me, controlling my body and thoughts. During these episodes, I often do silly things (e.g. burn myself on a radiator, take 10 paractemol etc.) I don’t think this is just depression, but maybe I am overreacting? I probably am a hyperchondriac? Please reply…i need help.

I am sorry but I really cannot give a reliable or exact diagnosis over the Internet. Based on your letter, it does seem to be more than depression but what for sure I do not know. You mentioned that you lie compulsively and that you are paranoid. You also do self-mutilate and self-injure. It’s also possible that you were hearing voices. These symptoms do seem to indicate that there is something more than depression going on but without evaluating you in person, I cannot give you a precise diagnosis.

You mentioned that you have been in treatment in the past but it is not clear that you are currently in treatment. You also mentioned that it was suggested that you take medication but you did not want to take it. If you are not currently in treatment you absolutely need to be. Medication could also help you especially if you are paranoid or hearing voices. Thinking that something evil is controlling you is a paranoid thought. I am also concerned about your suicidal thoughts. I do not think that you should try to handle these symptoms on your own and I would strongly suggest finding a doctor and a therapist. Please consider some outside help. Take care.

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How angry is it okay to be?

by Dr. Marie Hartwell-Walker September 8th, 2019
written by Dr. Marie Hartwell-Walker

Hi,

Two years ago I was living by myself 1200+ miles away from home. I was studying for a masters, but I was getting so depressed and going a little crazy by myself that I came back to live w/my family since this summer. I always thought of myself as lucky and blessed that my parents were married from the beginning (that they’ve been married for 25+ yrs).

Anyways, about a month ago, my dad decided that he no longer could stand my mom and asked her for a divorce. Never mind that my mom has not worked since they got married (a decision they both had made since they got married), but anyways. I make more money than he does right now. Since I graduated from high school and though I lived w/my parents during my bachelor’s, I took care of myself financially. Throughout all of my undergrad I would help my parents financially. Since I was living by myself I did a lot of things and spent a lot of money, so my debt, though not impossible to pay, it’s quite high for right now. My parents, on the other hand have a larger debt.

I got really depressed when my dad asked my mom for the divorce. He had given me a brand new car (not paid for), that I felt like smashing myself and the car through a wall. Sometimes I have a hard time stopping myself from doing it. I see a psychiatrist. He alerted my regular physician. He prescribed me some Seroquel (I didn’t have a good reaction to other anti-depressants in the past). I see a counselor as well, but it’s hard to see her b/c she’s quite busy, and I don’t live in a big city.

I’m really upset at my dad; I love him still, but right now my anger is so much stronger. The other day, I felt like driving us both to the wall, I guess that if my mom and my sister can’t collect my life insurance money, then they can collect his and pay for the house. He was the head of the family, and I no longer feel this is a family. He told me stuff about how he feels about my mom and keeps on making excuses to leave my mom. I’m unsure whether he is seeing someone else. In a way he is leaving us too. He leaves and leaves me a lot of bills. He says he’s going to try to live w/us for a year, so to pay for some bills, but I doubt he’ll stay for that long. Oh yeah, and his mom and one of his sisters are really sick and he has been going constantly this past 1.5 month to go see them. We’ve never gotten along and my parents have never drawn lines with them even though they have been mean.

I’ve been taking the Seroquel for 2-3 weeks now, and to be honest, I still feel so down; I get upset so easily and have a hard time not getting upset at my students when they don’t bring the homework or pay attention in class. I’m behind on a couple of papers I need to turn in, and for some odd reason I think that my hormones are a little off balance. I don’t know how to behave with him. I tried talking w/him but he is just not honest about stuff. Any advice?

Thank you for writing. You are understandably upset and angry. But you know that hurting yourself or your dad wouldn’t help anything and would only make things worse for your mom. As difficult as things may seem right now, they are problems to be solved, not reasons to end your life. What you need most right now is a plan and some support. Here are some ideas:

First, you need to go back to your psychiatrist and confirm that he/she thinks Seroquel is the medicine for you. Psychiatrists specialize in psychiatric drugs. He/she may have a different idea than your PCP. Whatever you are feeling right now is either a side effect of the medicine or your depression. It’s not the Seroquel. It takes up to 4 weeks for people to get a benefit from Seroquel so it may be that you are almost at the time when you will get some relief.

Next, you need to get in touch with your counselor. However busy she is, a good counselor will respond when someone is in crisis. You need to be seeing her at least weekly until you get your anger and depression under control. Your counselor can provide you with some important support and help you learn some new ways to cope.

I hope one of the things you will talk about with her is how to untangle the many unclear boundaries in your family. You are not responsible for your dad’s debts. He is. You are not responsible for your mom, your dad is. You can certainly offer to help out but it isn’t fair for your dad to count on you to take care of his responsibilities. Tell your dad that he shouldn’t be talking to you about your mom. He needs to be talking with her. You can’t fix years of bad feelings between your dad’s family and your parents so please don’t try. That’s your parents’ business.

Next, please see a credit counselor to help you make a plan for systematically getting yourself out of debt. You are only in your 20’s. My guess is that no one has taught you how to make a budget. A credit counselor will help you figure out how to pay down those debts and put you back in charge of your financial situation.

Finally, I hope you have a couple of friends to hang out with. You need to have some place to relax and just be accepted for yourself with no responsibilities attached except the usual reciprocity of friendship. Make time to be with friends and have their support through this difficult time.

If you are feeling desperate, please call the National Suicide Prevention Lifeline at 1 800 273 TALK. There are counselors available 24/7 to talk to you.

I wish you well.
Dr. Marie

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Increased depression since beginning therapy

by Kristina Randle, Ph.D., LCSW November 30th, 2019
written by Kristina Randle, Ph.D., LCSW

Q. I began therapy about 2 months ago. I said it was to help me decide about staying in my marriage or not, but really I was more concerned about my own behavior. After obsessively thinking about cutting for a year and half, I knew I was on the brink of actually doing it.

It took months to actually make and keep an appointment. The same week as my first session, I began cutting. At first it only took 4 or 5 cuts to calm down, but I’ve done as many as 50 cuts (after a particularly difficult therapy session). I’m worried that cutting gives me the best high. Although I’ve never done hard drugs, the high is what I imagine a heroin high to be like. Instead of feeling better about my life and seeing a decrease in cutting, I’ve been feeling more and more depressed.

I’m not sure what you need to know to answer my questions, but my childhood was difficult and abusive. In addition to cutting, I’ve engaged in S&M and drinking for years, especially when I was feeling out of control. OK…my questions….Is it normal to feel depressed and exhausted when going for therapy? Does this mean it is working or it’s not working? How long does it last? Should I stop going to therapy?

You have asked complicated questions. With regard to it being normal to feel depressed or exhausted when going to therapy, the answer is that it depends. Generally, I do think that feeling exhausted is normal. It takes time, energy, and devotion to decide to see a therapist and really work on your issues. Therapy can be emotionally draining. This may be especially true for you because you mentioned that it took you some time to decide to keep your initial therapy appointment. Clearly you struggled with this decision. What is important and encouraging is that you did keep the appointment. It shows that you recognize that you need support and guidance.

With respect to feeling depressed about going to therapy, I am unclear about why you are feeling this way. People generally feel depressed and then subsequently seek therapy. If I understand you correctly, you are feeling depressed about going. Some people mistakenly feel weak for going to therapy thinking that they “should” be able to fix things on their own. The more likely explanation is that you are struggling with therapy because it may mean an end to your marriage. Taking action to end your marriage may cause you to feel guilty and be a major source of anxiety. The prospect of ending a marriage is a monumental life change and is an extremely difficult decision. It is possible that your feelings of guilt are contributing to your depression.

The cutting may be your reaction to you deciding to engage in therapy and possibly end your marriage. Cutting is a form of self-punishment and is an inappropriate and misguided coping mechanism. If you are feeling guilt over the idea of ending the marriage then cutting may be your way of enduring the guilt. The cutting probably makes you feel better because you think that you are “paying for” whatever mistakes you believe that you have made, now or in the past, and this comforts you.

It is also believed that cutting is a form of self-control in that you decide how many cuts, how often, and how deep. What you must recognize is that the feeling you get from cutting is an illusion. The truth is that cutting is not only dangerous but it is a sign that your life is out of control. It may make you feel good temporarily but it is extremely and quite literally self-destructive. It is unhealthy for you to be abusive toward yourself. You mentioned that you were abused as a child. You endured abuse as a child and now are inflicting it upon yourself willingly. I hope that you come to realize that you have taken enough abuse.

I do not know if you should stay in therapy with your current therapist. It is clear that you could benefit from therapy but I am not sure if you have found good help. Have you talked to your therapist about the cutting? If you have not then you should. If you are not able to talk to your therapist about your cutting then you should find another therapist that you can open up to. It is normal for therapy to be difficult and exhausting but it is not normal for you to, after a difficult session, take to cutting yourself. I hope this provides you with some clarification. If you have further questions, please do not hesitate to write again. If you would, please consider writing in again to let me know how you are doing. I wish you luck.

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THere’s never peace in our house and I don’t know what to do.

by Dr. Marie Hartwell-Walker November 10th, 2019
written by Dr. Marie Hartwell-Walker

Hey. Well, I’m not exactly sure where to start so maybe I should give you a little background information. I am 15 years old and in high school. About 4 months ago my step father ummm “touched me” inappropriately. I take full responsibility for it because I know it has to be my fault. He has done it twice and that’s all. It’s been about 3 months now so I know it will never happen again. I’m not really worried about it that much.

I think though that I have depression. I go to school in the morning and I can’t focus and then I come home and I don’t want to do anything. I stay up until 4 am and I wake for school at 5am. I’m tired but it doesn’t matter how tired I am I still won’t sleep. My mother and step father fight all the time. My mom, when not indulging in an argument with him, yells at me. It’s never peace in our house. I have a younger sister who pretty much gets all the love. But she’s not free of the violence. My MOM beat her with a belt. < -- can you believe this? Well now the option has come up that I can live with my real dad and step mom. I'm just having a really hard time making this choice. He lives in another state tw. Also, my mom has always used my dad as a threat to me. Like " IF YOU DO NOT KNOCK THIS OFF YOU CAN JUST GO LIVE WITH YOUR FATHER AND SEE HOW MUCH HE CARES ABOUT YOU, I'M SO SICK OF YOU ATTITUDE." I don't want to hurt my moms feeling either, but I'm not happy with my life. She calls me a Bitch and though I'm no therapist she is, and I'm pretty sure you don't call your teenage daughter that when she already knows she is stupid and fat and has no self esteem. I have stooped down to cutting... yeah I know "how emo" right? Well, the cutting has stopped for now due to the horrendous marks that just won't go away. Another thing for me to stress about. I get stomach aches all the time and just wish for once life could be easy. I don't know where i went wrong but some how i did because the bad never stops. I get called "paranoid" because the first thing on my mind where ever I go is what everyone is thinking about me. When someone laughs i think there laughing at me. I always try to please everyone and lately I'm not pleasing anyone, not even myself. Do you think you can please help me out a little? I'm looking for what ever advice I can get. I have no one else to ask. Thanks!

My dear girl, What do you mean you take full responsibility???? You are the kid. Your StepDad is the adult. He knows what he did is wrong. Touching you in any sexual way is a crime! On top of that, your Mom and StepDad are fighting all the time and calling you names. I’m very, very worried about you and your little sister. We don’t know whether your StepDad has done the same thing to her. Neither one of you has a safe and nurturing home to grow up in. You are right to be looking for some help.

You are a sweet girl to not want to hurt your Mom’s feelings but I don’t see any way for things to get better – for her as well as for you girls – unless you tell someone what is going on so you get some help. No matter how much you want to please and protect people, you can’t expect yourself to handle something this complicated and painful on your own. Sadly, it doesn’t sound like your Mom would believe you if you told her about your StepDad or your depression so you need to go to someone who will.

You didn’t mention whether you have a good relationship with your bio-Dad in spite of your Mom’s threats. If you do, you could start by talking to him. If you don’t know him very well, it would probably be better to start with your school guidance counselor or school nurse or your medical doctor. Any one of them will know how to get your family the help they need.

If that idea is too scarey or if you need to talk things over with someone to help you decide what to do, you could call the Girls and Boys Town Hot Line at 1 800 448 3000. I just spoke to a very kind person there who told me there are counselors available 24/7 to talk to kids like you who need support. You don’t even have to tell them your name unless you want to.
Please write again and let me know what you decide to do.
I wish you well.
Dr. Marie

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My life has been hell for too long.

by Dr. Marie Hartwell-Walker March 9th, 2019
written by Dr. Marie Hartwell-Walker

My life for the past 3 years has been hell. I was married. My father was killed in a car accident. My husband was an alcoholic so I got a divorce. I met and married someone else. Now this marriage isn’t looking so good. I work 3 jobs and in the past 2 years my husband has had 2 jobs and both have only lasted a month or less. We’ve been married for almost a year, but haven’t even been together for 4 months during this time. He was supposed to be deployed to Iraq but got hurt before he left and was hung up at medical military bases and such. He’s now due to go back to Iraq in 2 weeks.

I just bought a house…my money, my credit, but his name is on the deed because of the law here. He doesn’t do anything around the house. He didn’t even help move because “it’s not his stuff” but that doesn’t stop him from using it. My Mom HATES him because she can see that he’s not doing anything. My brother doesn’t like him because of the stress it’s putting on me. My husband HATES my family. He thinks that my brother is going to steal his stuff while he’s in Iraq and wants to lock them up for safe keeping. We all live together in my house.

My husband sits around and plays video games while I’m out working. He hounds me to have sex until I finally give in. I hate having sex with him. It’s so painful to me and I just feel so used that I often cry or try to go to my ‘happy place’ until it’s over. He doesn’t seem to care. I told him that I wasn’t going to have sex anymore and he said that he’d go have an affair but then later said that he wouldn’t do it. I called my husband one day to tell him some really bad news and his response was “I can’t deal with this right now, I’m ready to quit my job.” (The job that he hadn’t even had 2 weeks yet).

My husband has two kids with two different women that he doesn’t take care of. One lives with my husband’s Mom and the other with the child’s biological mother. I want to have a family, but he doesn’t seem to have that same goal. He says he wants them when the time is right and he ‘won’t screw up their lives.’

I care about him and don’t want to hurt him, but I don’t know what to do. Before we got married, he had to promise that he would grow up and do what he had to do. (I had doubts before I got married.)It hasn’t happened. Now that he’s going to Iraq, he’s promising the same thing when he gets back.

I feel smothered and lost. I don’t know what to do. I feel like a failure because this is my second marriage and it’s not going great and I’m only 26. I feel that it is my job to make everyone happy and not hurt anyone. I am ready to give up. I don’t want to get out of bed if no one is around. I don’t want to go home from work if people are here. I’m tired of constant conflict. I really really need help. I just want to be by myself and not ever be around anyone again. Is my husband mean and lazy or am I oversensitive? Please help me before I break.

The kindest interpretation I can make of your husband’s behavior is that he is terrified of going to Iraq. It appears that he has put his life on hold, has made himself stop caring about others, and has shut himself down emotionally. He has been in limbo for quite awhile. He certainly hasn’t been able to make long-term plans. So maybe he’s been afraid to commit to a job or to you or his children or even to himself. It may seem to him that it will be easier to leave if he can convince himself that he just doesn’t care.

On the other hand, you also tell me he doesn’t support his children, abuses you sexually, and that you had doubts about this marriage from the beginning – in which case maybe you made a very wrong choice for many wrong reasons. Maybe you thought that having someone to love would help you with your grief over your father’s death or your regrets over your first marriage. Maybe there is something going on with you that you feel you have to make everyone happy, even at the sacrifice of your own health and happiness.

If your husband is headed for Iraq in the next week, it’s too late to make significant changes in your marriage before he goes. Wish him well. But please take the time while he is away to find a counselor, preferably someone who is familiar with military families, to help you sort things out. Regardless of what you do with your marriage, you have some important personal work to do to get out of your depression, to make good decisions and to get on with your life.
I wish you well.
Dr. Marie

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I hate life

by Kristina Randle, Ph.D., LCSW September 25th, 2019
written by Kristina Randle, Ph.D., LCSW

Q. First of let me just tell you that it’s ok if you don’t want to respond to me, i undestand. If for some reason whoever is reading this actually cares enough to respond heres my problem: I absolutly hate my life A LOT. I don’t get a long with my parents ever. They hate me. I don’t know what to do. I hate how i look. I have no self esteem. I am fat and disgusting and i know i am because even kids at school say it. I have no friends and my sisters are always fighting with me. I have tried to be bulimic. I found a website learning how. I don’t through up everyday, just on really bad days. I sometimes wonder if life would be better if i was dead but then i think of my dog and i dont want to leave her and i dont want to hurt anyone else. so i dont want to die i am actually afraid to. I tried to cut myself before, but i couldnt get up enough nerve. But really who cares about me anyway, right? My teacher sometimes calls me paranoid because i am always afraid that people dont like me. well news flash NO ONE LIKES ME. I dont know who to talk to because i am not good at talking about myself i get embarresed and think there are bigger problems then mine and im not important enough. I m just so tired of being me and i just wanted to know what to do i think i might be depressed. I don’t know but i am angry a lot and i hate my step dad. I hope you can help me a little. I’m sorry if my letter is stupid and i wasted your time.

A. Your letter is in no way stupid or a waste of my time. I am really glad that you wrote. I first want to say that I am sorry that you are so down on yourself. What I find positive about you writing this letter is that you cared enough about yourself to request help. To me, this is very hopeful. Even though your words about yourself were negative, I want to point out that you cared enough about yourself to inquire about how you can stop feeling so depressed. Your inquiry tells me that some where deep inside you, you do really care about yourself and know that you, like everyone else, deserves to feel better. Just by writing this letter, you have already taken a healthy and positive step in the right direction, to end your suffering.

My recommendation for you is to find a counselor. For you, I would specifically suggest seeing the school counselor. Also, you should talk with your mother and step father about your depression and tell them that you want to seek help. It is important that they know how you have been feeling lately, even if you do think they “hate” you. I know that seeking help and talking to your parents will be difficult for you since you mentioned that you feel that your issues are not important enough to warrant help.

You have written this letter and that is a good, first, healthy step. Your letter and my response both confirm the fact that you are experiencing issues that require extra help. Next, I strongly encourage you to take a second, more difficult step. That is, tell your parents about your depression and find a way to get into see a counselor. If you do not want to tell your parents, at the very least go to the school counselor and tell him or her what you have been feeling. Be open and honest with the counselor. Contrary to what believe, you must realize that you are important enough to receive help. Not only are you important enough, but it is your god given right to get that help, to feel better about yourself and to end your daily suffering. Your new mantra after reading this response should go something like this: I do deserve help. Thinking about it from another viewpoint, if your friend wrote this letter to you, asking you for advice, I am sure that you would not tell her that she was not worthy of help. Instead, you’d encourage her to get help or talk to her parents because she deserves to feel better, because she is worthy of help. If it is good advice for your friend, then it is good advice for you. Take care and write again if you have any questions or need further clarification about my response to your letter.

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