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Should I Be Concerned?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I am under more stress lately than I have been at any other time in my life. This is largely due to some major life changes– marriage, job change, moving away from my hometown– all happening at once. I am very happy about all of these for the most part, however.

Meanwhile, I’ve been having what feel like unusual psychological symptoms for several months now. I wonder if these can all be put down as to reactions to stress or if there is some larger issue that needs addressing.

To summarize, I began having troubles with self injury and mild dissociation (sometimes referred to as depersonalization according to the reading I’ve done) several months ago, off and on. I believe I understand how and why cutting is unwise, but sometimes I would do it anyway as it was a very effective way of coping for me. However, I made a strong and mostly successful effort to quit. Around the time I quit, I started experiencing extremely frequent suicidal thoughts and images. This is especially perplexing to me because I really don’t want to die nor do I feel depressed. I’ve tried ignoring these thoughts, but it has been most difficult.

Then, yesterday, I felt like I was hearing voices. I did not experience them as coming from outside my head, nor was I deluded into thinking they were anything other than my mind playing tricks on me. But I did experience it as a voice speaking inside my head, and as an interruption to my conscious thought processes. It was questioning whether my life was worth living, and urging me to harm myself.

Sometimes I maintain inner dialogs with myself, which I assume is fairly normal and harmless. This was not the same thing.

I don’t know. Ignoring it was fairly easy, but I’m wondering what all these symptoms could be pointing to, if anything. I realize you cannot diagnose over email, but could you give me any ideas of possible causes for these things?

I have been maintaining my work and social life about as usual. I’m a little more tired than is typical for me, but otherwise have not had any difficulties functioning as usual and having a healthy and normal family life.

Since these problems are not affecting my day to day existence, I wonder if they are even worth addressing. Still, they seem so bizarre and I’m honestly rather concerned. Please point me in the right direction, if you can.

You are describing a most unusual situation. On one hand you describe a part of your life in which you are able to function well. You are able to maintain work and your social life as usual. You say that other than being tired you basically have a healthy and normal family life. On the other hand you report experiencing very serious psychological symptoms which include suicidal ideation, voices telling you to harm yourself and dissociation. You also have instances in which you are driven to purposely injure yourself as a way to cope (although you did not say what self injury specifically helps you cope with). What is unusual about your situation is that typically when an individual is experiencing the type of psychological disturbances you’ve described (i.e. self-injury, suicidal ideation, etc) these symptoms tend to permeate all aspects of their life, not just compartmentalized parts. You described being able to “fairly easily” ignore the symptoms and even wondered whether they are worth addressing. It’s almost as though you are experiencing two distinctly different realities.

If I were able to meet with you in person I’d have many questions about your experiences. I would be trying to ascertain the frequency and severity of your symptoms as well as explore more thoroughly the voices, self-injury and dissociation. Without having access to much more information about your situation it is difficult to know what exactly you are experiencing. The fact that you are able to ignore these symptoms indicates possibly one of several things: (1) the symptoms are infrequent and not severe; (2) you are not reacting appropriately to your symptoms and thus have misjudged the seriousness of your situation; or (3) you’re experiencing a high level of dissociation. Please know that this assessment is based on very little information and therefore may be incorrect. Also, there may be other possibilities to explain your symptoms that I have not mentioned here.

Generally speaking you should never disregard self-injurious behavior, suicidal ideation, voices or dissociation. It may be easy to ignore these symptoms but I would never advise anyone to do so. You should be evaluated by a mental health professional. An evaluation is necessary to determine what if any treatment you should receive. What is good about your situation is that even though you seem to be experiencing serious psychological symptoms they have not affected your work, social or family life. This is very encouraging. To ensure that these aspects of your life remain uninterrupted please consider being evaluated by a mental health professional. Thanks for writing.

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Constant Failure

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

At the moment, I’m so mad at myself. It seems like everything I do just goes wrong and it’s bothering me and whenever I try to change a habit, I give up on myself so easily.

Right now, I can’t go back to college because I owe money and I decided to go to an expensive private which is an avoidable mistake. Yesterday, I failed my license test for the third time because I drove over the stop line, also easily avoidable. About a week ago, I had a job opportunity to assemble cell phones but due to failing my assessment test, I blew it.

Overall, there’s just this cycle of failure that constantly happens in my life and I can’t live with it. I feel like I’m not good enough because I can’t ever achieve anything I try and it just really bothers me. I’m 19 years old, never had a job before, overdependent on my mother, never had a girlfriend before and I always give up on myself when I try to change a negative habit.

I understand that there’s worse going on in the world but I can’t love myself when it seems like all I do is fail. Even as a kid, I was always the one that was bad at sports and learned how to ride his bike later.

I just don’t know what to do. Every piece of advice I’ve gotten hasn’t worked and I’m just really scared for myself. It seems like no matter how hard I try, I’m always just going to fail.

This sounds very painful. At this point, your conviction that you are going to fail is at least partly what is making you fail. When we focus on the possibility of making a mistake, it’s almost inevitable that we will do so. You need a big boost in confidence and courage so that you can start laying a foundation of successes to change your image of yourself.

Please give yourself a break. It’s not at all unusual for a 19-year-old to still be working on separation from parents, to not have a partner or to not have had a job. It’s not unusual to have a crisis of self-confidence and self-esteem at your age, either. The issue is not what has been but what you are going to do about it now.

Here are some steps you can take to make some progress.

First, you need to get more active. If you can’t find a job right away, start building a resume by volunteering. Human services never have enough help. Look into opportunities in your community and offer your services. It will give some structure to your days and a way to be useful.

Second, find people like yourself to hang with. Not everyone is an athlete. Not everyone is ready to date. Identify a cause or activity that you truly enjoy and find out where people your age are doing it. You don’t have to make instant best friends. But you do have to start hanging out with people so you can develop your social skills and start to create a support system of peers. Just working (or playing) side by side with people will help you start to feel comfortable. Some of those coworkers may evolve into friends.

Finally, understand that we rise and fall to our own expectations. If you expect to fail, you will. If you know your own strengths and play to them, you are more likely to succeed. Check out the Authentic Happiness Website at UPenn and take the Signature Strengths Questionnaire. Identify the strengths you already have. Then work with them. These are the foundation for being more successful.

I wish you well.
Dr. Marie

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How to get parents into therapy?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I’m a happily married 27 year-old living with my wife. My problem is with my in-laws. They have been married for 28 years… mostly not happily. Over the last few years and especially over the last few months things have been escalating with serious thoughts of divorce. The problem is that they simply do not know how to communicate and so they go around in circles when arguing often attacking/defending themselves and each other. My question is quiet simple:

How do you get someone into therapy who is not interested in seeing a ‘shrink’ or ‘paying someone to listen’?

This is a very good question, and I do have some thoughts I can share with you. But my views on this take a more functional approach to getting the couple into therapy rather than the usual path of helping a couple work together with a therapist for the goal of improving the relationship and staying together. Let me explain.

From your description they are not good or easy candidates for couples work because of their resistance and lack of motivation for healing. In these instances, since it looks like they are heading toward a divorce, I appeal to couples to save themselves a fortune and make one of three recommendations. All of these tend to move them out of the boxing ring.

I recommend a divorce mediator (NOT divorce lawyers). A divorce mediator is someone specifically trained in putting together a memorandum of understanding that saves the couple tens of thousands of dollars in the divorce process. But what it more often than not does is let the couple stand on the rake of reality with a third party present. The divorce mediators are trained to detect how ready a couple is to move forward in a divorce and are usually in the position of being able to recommend a professional couples counselor to help with the emotional issues.

Secondly, when couples are this cantankerous I recommend they do a couples weekend where they use an intensive approach such as Imago, to get the issues out and clarified. In these instances I make this recommendation by saying they have spent X amount of time together and they should give it at least one weekend to see if there is anything left that can be salvaged. I also point out that they will want to understand what went wrong in this marriage because it is likely they will make the same mistake again with their next partner and they should try to learn from this relationship how to avoid making that error again.

Finally, I implore them to go for a one-shot assessment with a couples expert who would see them once, usually for an extended session, to help them with the next step. Again, the approach is a functional one as I say that a divorce is expensive and a mediator, a weekend, or an assessment can save a lot. This often appeals to couples at a level they intuitively know to be true. The message is: just because you are angry at each other doesn’t mean you have to both waste your resources on fighting through lawyers. This, somehow, has been an effective approach.

Wishing you patience and peace,
Dr. Dan

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Do I Have a Mental Disorder?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

I have searched the internet constantly trying to find out what mental disorder I have. I know there has to be something wrong with me. I am 19 years old and I avoid everything. I don’t feel connected really with anyone other than my best friends. I only had one girlfriend in my life, but I can’t say it was a legitimate relationship because she did all the chasing and i just decided to give it a shot since I had never dated before. I can’t think straight at all anymore, I used to be so funny and insightful, but now I feel like my mind is cloudy and it takes full concentration to make a coherent thought. I’ve always been considered by my family someone with a successful future because of my A-B honor roll in school, but I would sleep through school and call in sick as much as possible to avoid socializing or trying hard at something. I always felt I could get by doing bare minimum, but life is coming fast and I fear I’m destined for failure.

I used to try to hurl myself in uncomfortable situations, like going to a rave or party, but every time I find myself either trying to gain composure in the bathroom, finding a place to sit down to not look like an idiot just standing there, or getting super shitfaced so I can try to socialize.

Sometimes getting drunk helps me get loose and have fun, but a lot of the times, usually if I’m around a girl I’m interested in, I freeze up and zip my mouth shut for the evening. I don’t think I’m ugly, I’ve always been told I was handsome, but I just don’t feel like I’ve developed as a person much, avoiding most unsettling things that could end in conflict.

I’m lazy, I have no passion, I can’t focus, I’m severely indecisive, and I feel like I’m ripping at the seams, and everyone will soon find out I am a failure. Like I had this grand facade that I was worth something my whole life, but it turns out i’m just really good at faking it. I’ve narrowed my results down to either social anxiety, avoidant personality disorder, co-dependency issues, severe ADD, or slow processing disorder. Maybe I’m making a problem entirely up in my head like everyone tells me, but I just need some peace of mind. I can’t keep obsessing over this, but I can’t help it. What do I have to do?

As bright as you are, you are not a mental health professional. You are trying to make a diagnosis without the education or training or experience to do it. I understand that you are worried about yourself. I absolutely agree that you need to figure out what is going on with you. But I think you owe it to yourself to stop seeking answers from an amateur (you).

You are asking important questions about yourself, your potential, and how to live your life. You’ve tried various “treatments” for your sense that something is wrong (alcohol, risky situations, a relationship) to help yourself. I admire the effort but think it’s been misplaced.

Please get yourself to a qualified clinician for an evaluation. Bring your letter and this response with you to give the session a jump-start. Be as honest as you can be. Once you have finished the assessment, the therapist will work with you to develop a treatment plan to help you.

I’m very, very glad you wrote. It was an important first step in acknowledging that you can’t pull yourself out of your funk alone. Please give a therapist a chance to join you in your efforts.

I wish you well.
Dr. Marie

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Difficulty Communicating & Processing Information

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

For years I’ve had trouble communicating with others. My use of language has always been overly literal and causes me to accidentally hurt the feelings of others. I might say something like “that’s irrelevant” meaning that a point a person made is irrelevant without remembering that it has negative emotional connotations attached to it. I have to remind myself to be mindful of how my words come across.

Additionally, I have some trouble receiving information. If someone strings together too many words in a sentence, I frequently have to repeat the sentence to myself 2 or 3 times and sit on every word before the full meaning settles. Even then, I frequently miss the point.

I’m working on a Ph.D in a mathematical discipline and, recently had a professor grilling me as an unexpected oral exam. I couldn’t figure out what it was he wanted from me until nearly two hours after I’d left his office and I thought about what his questions might have meant at length. This happens very frequently and usually during conversations where I don’t have a prepared response to a particular question, I have to sit and think very hard about what was asked.

I’d like to either learn to communicate better or deal with this, but I don’t know where to turn.

My assessment of your situation is that you may have an undiagnosed language disorder. Having a language disorder means the individual has difficulty comprehending written or spoken systems of communication. Characteristics of language disorders include using improper words, misunderstanding the meaning of words, having difficulty expressing ideas, using incorrect grammar patterns, having a limited vocabulary, and difficulty following directions. Individuals with language disorders often have difficulty trying to understand words and their meanings. They also have trouble getting others to understand what they are trying to say.

According to Psychology Today, a language disorder is defined as, “a communication disorder in which a person has persistent difficulties in learning and using various forms of language (i.e., spoken, written, sign language). Individuals with language disorder have language abilities that are significantly below those expected for their age, which limits the ability to communicate or effectively participate in many social, academic, or professional environments. Symptoms of language disorder first appear in the early developmental period when children begin to learn and use language. Language learning and use relies on both expressive and receptive skills. Expressive ability refers to the production of verbal or gestural signals, while receptive ability refers to the process of receiving and understanding language. Individuals with language disorder may have impairments in either their receptive or expressive abilities, or both. Overall, people with this condition have deficits in understanding and producing vocabulary, sentence structure, and discourse. Because people with language disorder typically have a limited understanding of vocabulary and grammar, they also have a limited capacity for engaging in conversation.”

To read more about language disorders in adults you may want to visit the websites listed below.

Adult Speech-Language -Hearing Association

Voices.com

About.com Expressive Language Disorders

I would recommend being evaluated by an audiologist or a speech and language pathologist (sometimes called speech therapists). Generally, speech and language therapy are the best treatments for language disorders. Psychotherapy may also be considered if an individual is having difficulty with social interaction. Social skills and speech training may also be helpful. Social skills can be taught by a psychotherapist or a mental health professional that specializes in teaching these skills. Here’s a link to help you find a local speech professional in your community.

I would also suggest visiting your university’s disability services office. They may be able to link you to a speech professional for an evaluation. The primary job of the disability services staff at universities is to assist students who need “reasonable accommodations” in the classroom. For instance, because of a possible disability you may require extra time to take an oral exam. Staff at the disability services office can usually assist with these accommodations.

I hope this information helps to guide you in the right direction. Thanks for writing. I wish you well.

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Major Depression Seems To Be My Ball And Chain

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I’ve been on antidepressants since 1985. I’ve had a bunch of therapy over the years mostly in the mid to late 80’s. I believe I understand and have dealt with my childhood issues.

Every few years or so I have to switch meds because they stop working. As you probably know this can be a hellish experience. I’ve been off of Cymbalta for 20 days and was hoping that the worst was over… but I’m not sure. I’ve been on Nortrriptyline for about a month at a very low dose (25mg) because I don’t like certain side effects and will likely taper off of the 25mg. I’m hesitant to go forward with different meds because of when I have to switch again. My Psychiatrist is suggesting Zoloft based on the drugs I’ve already been on.

I’m kind of scared…I feel so agitated/angry/crazy at times. If you asked someone who knows me their first thoughts about me they would include something about how much I love animals. We’ve got 2 high energy dogs (herding breeds) that I take out daily to exercise (them and me). Usually we walk for an hour and I let them run in an open field at the end of the walk. Lately (the past week or a little more) I feel so irritated by them when we go for walks or for a car ride to the dog park that I am almost abusive to them. Yelling at them in the car just because they are panting too loud! What is wrong with me? Is this from the Nortriptyline? Or part of the problems coming off of the Cymbalta? Or is this some new depression thing? Whatever it is it is really awful and I wish someone could just put me out of my misery.

You are currently in the midst of a medication transition. You have described that experience as “hellish.” Many people would concur with that assessment. They too find it to be an unpleasant process. It is “hellish” largely because of the emotional dysregulation that often characterizes that experience. It is very likely contributing to your current feelings of agitation, irritability and your overall emotional instability.

You should consider returning to counseling. You tried counseling approximately 20 years ago yet the depression has remained.

Therapy could be advantageous for several reasons. One reason is that it might clarify whether you are currently having a depression episode or if your symptoms are associated with the transitional medication process. Secondly, a therapist could assist you in the development of relaxation techniques that might increase your emotional stability during this transitional period. Finally, therapy could help you to address your symptoms of major depression that have been your “ball and chain” for more than a quarter of a century. There are effective therapeutic modalities that can significantly minimize your depression or eliminate it from your life. Psychotherapeutic treatments have advanced a great deal since the 1980s.

I would encourage you to discuss your symptoms with your psychiatrist. He or she might prescribe a medication that can quell your agitation and irritable feelings while you are transitioning to a new set of medications. Also, I hope that you will consider counseling. A competent therapist can help to permanently remove depression from your life. I wish you the best. Please take care.

Dr. Kristina Randle
@DrKRandle

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Extreme Emotional Detachment

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I’m an extremely introverted person, and I have been for a very long time. It was different when I was younger, and I don’t know when or why that changed. I was as loud and obnoxious as any other child. I spoke my mind and made friends relatively easily. Now, at the age of 23, I find that I’m unable to express extreme emotions, and it’s hindered my ability to form meaningful relationships – platonic or otherwise – in both my personal and professional life. Although I have many different “friend” groups and a few friends that I would consider close, I’ve never felt that I really fit in with any group in particular, and I’ve never had a best friend who also considered me their best friend. I’m likeable – level-headed, polite, easy to get along with – but no one absolutely loves me or hates me. My longest relationship lasted 4 months, during which I spent more time trying to avoid them than anything else, and I’ve never been anywhere close to being in love. Most of my other romantic endeavors have been little more than casual hookups with little to no emotional connection.

In my professional life, I’ve been unsuccessful at building a network, which is crippling in a world where who you know means everything, no matter what you’ve accomplished. I’ve had more than one employer tell me I’m great at my job, but they regretted that they weren’t able to get to know me on a more personal level. I rarely make it past phone interviews because even though I may be saying the right things, I sound monotone and unenthusiastic. There are few things that excite me, or anger me, or make me sad to the point that it shows, and sometimes I can’t even tell if it’s because I just don’t have the capacity to feel those emotions or if I’m just suppressing them. I can count on one hand the number of people who’ve seen me cry. What I do know is that I want and need to be able to make these kinds of connections and learn how to express myself, but I don’t know how. I’m looking for advice on where to start and considering if seeking a professional would be necessary/helpful?

It is your opinion that your lack of extreme emotion is preventing you from developing certain relationships but I’m not certain that your self-assessment is accurate. Generally speaking, extremes in emotion are a sign of psychological instability and possibly a mental illness. For instance, individuals with bipolar disorder experience intense periods of happiness and sadness. Those intense periods of sadness and depression are referred to as episodes. Treatments for bipolar disorder attempt to balance one’s emotional state.

Psychologically healthy people have stable moods. We all experience periods of mood instability from time to time due to illness and sleep deprivation, among other reasons but those periods should be fleeting and short-lived. Extremes in emotion are draining and unsustainable. The fact that you lack these extremes in emotion is indicative of psychological stability and not necessarily a deficit or a problem.

Consulting a mental health professional would be advantageous primarily because it would afford you the opportunity for an objective evaluation. It’s possible that you are correct, and there is a deficit in your emotional response, but each situation would have to be assessed and dissected. A clinician could analyze those situations and determine if your emotional reaction was appropriate or not and advise you accordingly. You may only need a few counseling sessions to determine if anything is wrong and to learn the appropriate skills for dealing with certain situations. Counseling could be very beneficial for you. Please take care.

Dr. Kristina Randle

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Suffering From Depression?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I feel like i have always suffered from depression but i’m not 100% sure. To start off with the issue/issues:

1)I have always been bullied for most of my life from elementary school onward not so much anymore. I was either mainly bullied by my siblings(brother and sister)when i was the middle child growing up. They picked on me for whatever reason they could think of. One main reason they picked on me was my weight. I was also bullied by peers in my grade, and or friends.

2)I have always been extremely shy, and i struggle with low self-esteem. As i got older, the low self-esteem was still there, but i have now noticed that i am extremely self-conscious of the way i look, i have always struggled with my weight, and i usually hate looking in any mirror because i can see all of my flaws with how gross and ugly i look from being overweight. I do believe this is a form of body dysmorphic disorder? i’m convinced i have it.

3)I was diagnosed with a learning disability so whenever it came to school, i struggled with that and grades sometimes. It was especially hard during the spring semester of the new college i was going to because of the harder classes. Even though i did well for the fall semester. I didn’t realize that i get anxiety a lot, with school but i do.

4)continued from number 3: I was seeing a counselor at the school that i was going to for the fall semester of 2012, because i was super stressed and anxiety driven. I continued seeing a counselor at school for the spring semester 2013, both of them said i had depression. The last one i was seeing said that counseling would not help, but medication with the counseling helped. I learned the hard way when i was at college during the spring semester that college can be extremely lonely at times. I was even hospitalized for suicidal ideation. At that time i was put on 3 medications, i guess all for depression. I have yet to see my doctor about it though even though its been 6 months from that specific incident.

However now that i’m home i’m still convinced that i have depression like the counselor and hospital said. Could the issues that i have struggled with all lead to major depression. any advice would be greatly appreciated.

Yes, the issues that you are struggling with can lead to depression. It’s good that you are seeking professional help but it seems that you require more help than you are currently receiving. As you mentioned, it’s been six months since you have seen your doctor. That’s too long to go without professional help, especially after being hospitalized for suicidal ideation.

The counseling that you have been receiving at school is a great first step but it’s not enough. Typically, college counseling centers are geared toward assessment, emergencies and short-term problems. Given the chronic nature of your depression, you would benefit from professional help that is more intensive and long-term.

I would recommend seeking mental health treatment, outside of the college counseling setting, that involves both counseling and medication. You can ask the school counselors for a referral to a therapist in your community. You can also check with your primary care physician for referrals. They can assist you in receiving the proper help.

The issues that you have been struggling with are correctable. Your depression has been chronic perhaps in part because you have only just begun to receive mental health treatment. Once you’re established with a long-term therapist, and have found a medication that provides symptom relief, your quality of life should improve greatly. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Is There Something Wrong with Me?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I’m starting to think there is something wrong with who I am. People seem to act coldly and distantly towards me. The group of friends that I call myself a part of don’t seem to want to be around me – I only see them at school, they often make plans to go out as a group, which I only find out about after they have already been done. They openly talk about ‘the fun they all had’ over the weekend in front of me. They don’t contact me outside of school. I have tried making new friends, but people tend to treat me weirdly when I talk to them and this has made me nervous about initiating conversations. I think it’s my fault, somehow, that they see something about me that I don’t realise and this makes me undesirable to be around.

I never really noticed it before, but I think it has been happening for my entire high school career. Now that I know, I am comparing my behaviour with everyone around me, seeing myself as ugly even though I didn’t before, and I have trouble sleeping because I lie awake in bed at night, considering all that is wrong with me that makes people not like me.

I know that I sound pathetic, but that’s not my aim. It’s like nothing I say or do comes across the way I want it to. I’m starting to dislike myself, and occasionally I will apologise to myself in the mirror for being the way I am.

I also think my teachers don’t like me, because I am quiet and I never participate in class and because I act very strangely. I get good marks, though, so I don’t know.

I think it goes without saying that I have never been in a romantic relationship.

To answer your question directly, there’s nothing wrong with who you are. You may be experiencing depression. You are beginning to dislike yourself. You see yourself as “ugly” and “undesirable.” You are blaming yourself for the behavior of others and assuming that you’re the problem in all situations.

People with depression don’t think highly of themselves. Their view of the world is negative and pessimistic. They tend to see themselves as a burden, believing that others would be better off without them. That line of thinking can lead someone to isolate and withdraw from the social world.

Your assessment of this situation may be inaccurate. Depression clouds judgment. You could benefit from therapy. A therapist would objectively analyze your life and determine what treatment is most appropriate. A therapist will assess your social situations, your friendships and the way you interact with others. He or she will also determine whether or not you have depression and if the symptoms are interfering with your relationships and social situations. It’s important to proactively begin treatment when distressing symptoms emerge. This problem can be easily corrected with the assistance of the right therapist and treatment. I hope you will consider professional help. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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What is wrong with me?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

Its been years since i really enjoyed..well anything. I can sit down and like doing something, tv, books, chores, walking the dog, or just going for a run. I am capable of getting up and doing it all. I do what needs to be done. I have never really had a favorite color, or favorite TV show or even a favorite thing to do. I like everything yet I like nothing. I feel indifferent about everything i do. To include work and everyday chores. I do it because i know i have to and because i have kids that are depending on me or it is my responsibility. I find myself crying over everything. I cried when i read some of the other posts because they explain some of the feelings i have that i can’t seem to explain. I cried over my kids eating breakfast and i am starting to cry over this because i feel stupid for not knowing why i constantly feel ‘not normal”. Lately i feel like i am making it all up in my head. Its like i so desperately want some one to give me an answer for everything that I am making it all up. That there is really nothing wrong with me and everyone feels like this.

Now to come full circle. With all of this inadequacy that i feel at work i wonder if its the job. I have looked at other work. But because nothing really makes me happy would leaving really benefit me. I have never known what i wanted to do and i know i could make plenty of money staying where i am being miserable or i quit and face the same problems in another career field. I am so afraid of disappointing the people at work by quitting that i would rather have been in a total wreck to where i couldn’t go any more. My memory has been failing me lately, to a point my husband wants me to be check out; I would rather have a brain tumor than face my boss and have him hold a grudge for me not being able to handle all of this (more tears).

I feel almost like the things that happened with my ex caused me to start this downward spiral. I want an answer to what is wrong but fear the answer. HELP!

I didn’t include all of your long letter because the most important part of it involves your feelings. It sounds to me like you may have been suffering from dysthymia for some time. Dysthymia is a mood disorder where the individual is chronically depressed but at a lower intensity than in a full blown depression. As you report, it can go on for years and it can make life feel endlessly gray. I don’t know if your negative experiences with the former boyfriend are at the root of it. It may be that you would feel this way even if you’d never met him. He gave you reason to be angry and sad but it’s possible he only worsened an ongoing condition. As far as the job: It’s just true that wherever you go, there you will be. Changing the job won’t change your mood. Changing location won’t either. If the man you are with is a good guy, leaving the relationship also isn’t likely to help.

Instead, you need to see a mental health counselor. Bring your letter with you. You wrote an eloquent description of what you’ve experienced and felt. Your counselor will be able to hear more details and will be able to make a more sophisticated assessment. The two of you will then discuss treatment options. Some medication may be helpful to lift your mood a little so you will have the energy and interest to take better care of yourself and to take better care of your family. Some therapy will give you both some much-needed support and some practical ways to manage your gray moods.

You made an important first step in writing. Please follow through and get the help you need.

I wish you well.
Dr. Marie

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What Is Wrong with Me?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

I have been experiencing alot things in my life that are negative.. like i use to be a person who was down to earth and fun to be around with but all of that has changed.. i have only one best friend but i dont want to drag her down with this problem i have.. I get very nervous and i sweat alot when i am around alot of ppl and i tend to feel dizzy and not able to be myself. I have been really quiet lately and have declined alot of hangouts with my friends and have been staying at home. I usually get a feeling of emptiness inside of me everyday.. and i would sometimes think alot and my mind would go crazy.. i cant focus, i work fulltime in the summer to keep me busy.. i feel paranoid and ppl always talk crud about me behind my back or make fun of me.. i think i have low self esteem and confidence, and few times in life where i wanted to attempt suicide but didnt go through with it cuz it would be a coward move.. i just want to know whats wrong with me so i can pull my life back together, i was never like this before its like my life turned upside down. I admit its been a year since my last relationship and things that go on with my friends nowadays make me not trust anyone too.. srry for my bad grammer.

PLZ help!!

It is difficult to determine with certainty what diagnosis you have. My limited assessment of your situation is that you have symptoms of anxiety and depression. On some occasions you feel very nervous, begin to sweat and experience dizziness. You might have experienced a panic attack. Generally speaking, these symptoms are consistent with an anxiety disorder and possibly, panic disorder.

In an effort to escape feeling anxious, you avoid interacting with others. This is a mistake. That may seem counterintuitive but the avoidance of anxiety-producing situations will ultimately increase your anxiety. Combating anxiety requires that individuals force themselves to endure it and not avoid situations in which it might arise. I understand this might be hard but it is the most effective approach to eliminating anxiety.

Your symptoms of depression include: feeling of emptiness, inability to focus, low self-esteem and confidence, and a history of a suicide attempt. Anytime an individual gets to the point where they have contemplated suicide, it is a very serious matter. You should strongly consider treatment.

I would encourage you to have a psychiatric evaluation. It could help to determine if you have a diagnosable disorder. In addition, you should consider psychotherapy or medication. These issues might be difficult to solve on your own and may require the assistance of a trained mental health professional. Click the find help tab at the top of this page to help locate a mental health professional in your community.

I hope this answer helps you to better understand what may be wrong. I wish you the best. Please take care.

Dr. Kristina Randle

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Hearing myself in my head

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

I’m not sure if i have depression or anything like that. I’ve never been diagnosed. I’ve been having this issue for a while now and its getting more prominent as the days go by. I’ll be sitting and playing a video game or watching a movie to try and distract myself from myself but it seems to make it worse. I’ll be sitting and then i start hearing my own voice in my head but when it speaks, all it says to me is all the negative emotions that i feel. it tells me that i’m a loser, I’m lazy, and it asks me what am i doing, why do i bother to continue living. I’m worthless and nothing but a bother to my girlfriend. I know at this time I’m not the most active. I’m looking for a job at the moment and when the school year rolls around I’m going to be going back to school to get my life back on track. But anytime that i sit and try to do something a get overwhelming thoughts running through my head telling me things that i can’t shake. Its like my mind knows all my weak spots and aims for them. sometimes it asks me about my relationship with my fiance and says things like “you don’t really love her, you’re just using her, everything you say to her is a lie.” and i end up screaming back at it to shut up. I’m not very good with words so i’m sorry if this description isnt very good at describing. I’m very lost in my emotions and my thoughts and i would like any sort of help. Please, i need any kind of help.

You did a fine job describing your experience. This certainly sounds like it may be depression. You didn’t mention what you meant by your life being off track. But you did indicate that you’re out of school, unemployed, and feeling generally worthless. It sounds to me like your self-esteem has taken a big hit.

I agree with you. You need some help – more specific help than I can give you without talking to you to get a more complete picture of what is going on with you. There are medical problems that could be contributing to your symptoms as well as psychiatric ones. I urge you to talk frankly with your doctor. Inadequate sleep, recreational drugs, or alcohol abuse can contribute to these kinds of problems so be sure to share anyhing relevant in those respects. If you are medically fine, then ask for a referral to the local mental health clinic. If being unemployed also means that you have no health insurance, explore whether there are therapists in your area who work on a sliding fee scale. You at least want to get an accurate assessment and some recommendations for how to get some peace from all those negative words in your head.

Please follow through. Nobody deserves to be mentally beaten up like this day after day.

I wish you well.
Dr. Marie

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I’m in love but lost my libido

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

I have been in a relationship for almost 5 months now with someone I’ve known previously for about a year and a half. The relationship itself has been going great and I really think I am in love, however lately, I am feeling completely devoid of my libido. I am attracted to my partner but the attraction is not translating into sexual desire anymore. This has been a pretty recent thing (2 weeks or so) but it has been almost impossible for me to even have sex because i practically physically reject it. There are stress factors in my life right now, but I’ve been stressed before and its never had this drastic effect on me physically. I’m trying to figure out if I’m loosing sexual desire for my partner as we get more and more comfortable together or if its just something with me (which I feel is more likely because until recently I’ve always been crazy attracted to him). I still enjoy spending time with him, but I really want to get the sex back, it was a great part of our relationship and something I personally enjoyed.

It’s certainly possible that this is about the stresses in your life. Sex may feel like one more demand on an already overloaded system. You may be wanting comforting and quiet reassurance more than the excitement and intensity of sex while you are sorting out other issues.

However, it may also be that you’ve hit a decision point in your relationship. Somewhere around 3 – 6 months into a relationship, people start asking themselves if this is a relationship that will last. Once the glow of newness has slowed down some, we take another look at the person we’re with and make another assessment about our readiness to commit. Sometimes people do this consciously. Sometimes it’s the unconscious that does the work. If this isn’t about your stress, it may be you are sensing that you’re not really ready to settle down or that there is something not quite right about the fit between you.

I suspect that a factor that makes it harder for you to do this reevaluation on a conscious level is that the two of you knew each other before you became a couple. You may think that you already knew what you needed to know and that there’s something wrong with you if you find something lacking now. That’s not necessarily true. Sometimes people love each other in a friend or almost sibling-like way; not in a committed lover-type way. The relationship is in fact loving, caring, and supportive but it’s not sexual. Maybe you tried out whether this friendship could be taken to the next level and have found that it can’t. If that’s the case, I hope you both can back off and still care for each other. Good friends are hard to find. There’s no need to lose a friend just because you don’t have the chemistry of lovers. I know it’s not always possible to mutually decide to put the brakes on but it’s worth a try.

Then again, if you’re not ready to commit to one person (and at only 25, that may be the case), then it’s only fair to tell your partner so. If he can agree that you two can enjoy each other without implying that you are getting ready for long-term commmitment, it might work. Or – if he’s the marrying kind – he might decide to move on.

I’m sorry not to be able to give you a definite answer to your question. I hope, though, that I’ve given you some useful things to think about.

I wish you well.
Dr. Marie

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My husband handles our kids childishly

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

Q: My husband and I have been married for 10 years. we have two childen between the ages of 7 and 12. Over that time we have been through a lot in our relationship.He finally stopped drinking a little over a year ago and he has been doing very well with that. I guess I thought a lot of his behaviors and the way he treats others must be because of his drinking and I convinced myself that when he quit drinking everything would be so much better. He would finally be the man I wanted, a leader for our family..

He went to a program to help him stop drinking and it really was a wonderful program.they do not use the typicall 12 steps program but rather dig deep and figure things out. They tought him and myself that he drinking was a result of selfish behavior among a lot of other things and helped him learn how to deal with things.He came home happy,motivated,positive,helpful and just a well rounded individual.

Fast forward to today and the man you would see is the man I knew for so long with a drinking problem only one thing.. He doesn’t drink! He is insecure,immature,selfish,unmotivated,unhappy and just a downer to be around to be totally honest. Being a wife of a long time drinker I only have to look into his eyes to see if the man has had a drink so I know for a fact that he is NOT drinking. I have left the days of worrying about him starting up again, I really cannot imagine him doing that. But it has been used at a threat that if I ever leave him he will drink again beacause he only stopped drinking for me. I know it is untrue but he says it none the less.

So here is the problem or problems really. I feel like I am the only adult in the house. He rarely corrects the children unless what they are doing directly effects him. What I mean by this is that he doesn’t correct them to teach them right from wrong so that they will grow up knowing the difference but reather corrects them when what they are doing is bothering him in some way. He would not agree with that statement but it is my assessment none the less. When for instance my daughter jokes around with him and says something that hurts his feelings (something that she had learned by him doing it to her) he lashes out with a punishement like going to bed early. No talking just go to bed. Now if she hurts his feelings I have suggested something along the lines of.. “that really hurt my feelings that you said that, it was totally out of line. You cannot treat people that way because it is unkind. You need to appoligize, then brush your teeth and go to bed.” I understand he is a man and may not express himself as I would be something along those lines to get accross what we are trying to do.. and that is teach her to concider other peoples feeling before you say something so that we are not unkind to others.But that is not his goal.. His goal is to hurt her feelings as she has hurt his. Then she tried to appoligize and he would even let her get the words out.. He just said leave me alone. He will continue to be mad at her for days. Whenever he can get a jab in at her about it he will and she will retreat to her room when he gets home from work rather that dealing with him because it hurts her so deeply that she cries each time he rejects her. He will eventually get over it but it will be days of ignoring her and making comments before this happens.

I have spoken to him about it. I told him (when I was still calm) what I stated before about how we need to teach them right from wrong not just lash out because our feelings are hurt.. that when we are parenting we have to take out the emotions and teach. When I was rebuffed rather meanly I raised my voice. I still was not yelling but it was raised and i was not as kind..I said something like.. “You are not 5 years old you are an adult, grow up and act like one. You have to express yourself to her so she understand and stop holding a grudge for days. You are a parent…act like one.” and I left the room.. he responded with a snappy comback and we are not speaking.

I don’t know how to handle him or talk to him. It seems like everything is about him all the time. He doesn’t react to good grades from the children, he doesn’t react when I tell him something positive. We get this chilling “oh cool” from him.. thats it. No encouragement,no praise.. It drives me crazy. He has no goals, no dreams, no hobbies unelss you count an online video game that causes agruments. He doesn’t have any friends. I mean no friends at all. He doesn’t recieve phone calls exept his family and they complain to me that he doesn’t answer the phone. (I don’t know what the heck they want me to do about it) I just don’t even know what to do with him. I sometimes feel like leaving and I just don’t think it isn’t the right things to do.Leaving him isn’t going to change the way he parents them. How do I talk to him? How do I get him to understand what he is doing when he handles our children is hurting them not helping? How do I keep from going crazy? I just need some advice.. Please help

I wonder what happened to the guy who came home from the program? Your husband has reverted to his alcoholic self – without the alcohol. This is called being a “dry drunk”. He has stopped the drinking but he is doing all the alcoholic behaviors. Meanwhile, you are shouldering all the responsibilities of parenting and the children (and you) are being emotionally abused. I suggest you get in touch with the program that seemed to do your husband so much good and see if they have a “refresher course”. You could also look into whether they have a support group for spouses. Another resource for you is Al-Anon. I strongly urge you to find a group – whether or not your husband approves. Al-Anon has a solid program of practical advice and support for family members of alcoholics. Their website is http://www.al-anon.alateen.org

I wish you well.
Dr. Marie

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Which doctor has it right?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

I have been going to a clinic to find out about some health problems that I have been having, and was seen by three different doctors with three different diagnosis. I have been having trouble concentrating, remembering things and keep zoning out when I am driving to work. I am always tired and although I always get 7 to 9 hours of sleep a night, have trouble staying awake. I get frequent headaches and dizziness accompanied by nausea. Last Saturday, I was dizzy for the entire day and had numbness and pins and needles feelings in my face. I have been going to the clinic trying to figure out what is wrong and each time I see a different doctor. I am currently on effexor and feel great with it. I have had problems like this with dizziness, headaches, nausea and zoning out while driving in the past before being on this medication, so I know it is not a side effect.

The first doctor that I saw said that either I was having trouble sleeping or that it may be neurological, put me on amnatriptaline, and said if this didn’t work she would refer me to a neurologist. I took it for a week and a half and was still zoning out while driving (45 minutes to work), and being very forgetful. I went back and another doctor saw me. She said that she was going to give me some samples of Zyprexa, that she believed that I have bipolar and was not in need of a neurologist, and she wanted to see me in two weeks. I was unable to return to the clinic that Tuesday, so didn’t have the medication for another week. It was that saturday that I had the dizziness and numbness. I went back for a third time this past Tuesday, saw a third Doctor, and told him that while the medication did help me think a little clearer, I was still having problems driving and the Saturday that the dizzy spell happened, I could barely recall getting to work. I said that I need to find out what is going on because it is not safe for me to drive this way. He told me that I have severe panic disorder and that a 24 year old should be perfectly healthy and not be afraid for her life or the life of others and gave me zanax.

Now, I have had panic attacks before, and I know the numbness that can accompany hyperventilation. I can see where he may come up with this assessment, however, I had none of the fight or flight feeling associated with panic attacks, and was acctually not upset about anything other that the physical problems that were going on. Could the dizziness and pins and needles feeling really have been anxiety and panic, even though I felt calm? And I still don’t understand what is making me fall asleep while driving. After I started taking the zanax, I slept for two days and was very irritable the moments I was awake. I cut my dose in half and am able to function a little better.

I still don’t see any of the problems I was initially seeking help for going away. Also, I don’t really have an overabundance of stress right now, so I haven’t had any feelings of panic for quite some time before the doctor put me on this. Should I go back to one of the other doctors, or does this sound like it is panic disorder? I do not want to discount any of them, however each told me the medication prescribed prior was really wrong, and this one is the one that makes me feel worse instead of better. thank you very much for reading this and any help you may have for me.

I’m sure that each of the doctors had a good reason for the diagnosis he or she made. I’d suggest you go back to doctor #1. The other two are treating your symptoms as psychological. Maybe they are. Maybe they’re not. Before I’d accept a psychiatric diagnosis, though, I’d want to positively rule out an undiagnosed medical condition. Given the symptoms you report, a referral to a neurologist as soon as possible makes sense to me. If the neurologist’s report comes back fine, I then suggest you see a psychiatrist. Psychiatrists specialize in the medications you’ve been given and are more conversant in possible side effects. If you do need psychotropic medication and particularly if you seem to be sensitive to them, you want to be seeing a doctor who is sophisticated in their use.

In the meantime — why are you driving? By risking that you may again fall asleep at the wheel, you are endangering yourself and others. Your life and the lives of others will be altered irrevocably if you cause an accident. Please find someone to take you to and from work until you get to the bottom of this.

Please write back and let me know what you find out.

I wish you well.
Dr. Marie

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