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I can’t forget about my ex-boyfriend

by Dr. Marie Hartwell-Walker October 30th, 2024
written by Dr. Marie Hartwell-Walker

I was with my ex for 5 months. It was the “first love” for me, so probably I was seeing more in that relationship than there really was. He left me for another girl a year ago. I should have stopped talking to him the same moment, but I was stupid and tried to make him come back to me. When the girl left him, I was by his side, but when he found another one I just couldn’t stand it and told him I’d rather not see him again.

I know that this sounds stupid, but my mind has no influence on how I feel. I love him, but I wasn’t worth him. Everyone was telling me that time heals the wounds, but it’s been a year and it’s only getting worse. I miss him, I cry at night because of that. I’d do anything to be with him, even for a moment, even to be able to touch him. And I know I mean nothing to him, he probably even forgot that I exist. Every time a smallest things reminds me of him I feel as if someone throw a huge, heavy stone inside of me. I can’t ever imagine being with anyone else. I know I’m broken and not worth fixing, so hoping someone could love me has no sense. I just don’t know what to do, I know nothing. For some time I wanted to kill myself, but I’m too weak.

There’s one more thing I fear. I’ve always wanted to go to Medical University, but that’s where my ex and his current girlfriend study. I’m afraid that I won’t be able to bear this if I see them together and it would be 4 years on the same university… If I run away from him, I’ll lost the last thing I want and can have. For a year I haven’t been really happy and I’m afraid I won’t be anymore. Even writing this the stupid me is crying. I just really don’t know what to do.

A; I really am sorry that you have been feeling so sad for so long. First love is often a very powerful experience. But you already know that your feelings are way out of proportion to a 5 month relationship. When someone becomes so obsessed and depressed that she can’t function, it usually means that there is more to the situation than a broken heart.

One way to figure it out is to ask yourself what you would be thinking about and doing if you were not so upset about the breakup. Is it possible that it is easier for you to maintain the upset than to face whatever it is that you should be attending to? Could it be that you are anxious about going on to university, for example? Or maybe you are so afraid to open your heart to someone again that there is a part of you that would rather be stuck than chance it.

I want to remind you that there are medical schools all over the world. If you don’t want to run into your ex at school, you could look into alternative places. There are lots of worthy men your age in your city, in your country, and in the larger world. Someone out there is looking for someone just like you. In either case (school or romance), you won’t find what you are looking for by sitting home and thinking about one failed relationship.

Most important, I don’t believe for a minute that you are “broken and not worth fixing.” Your self-esteem and self-confidence have suffered a blow but that doesn’t mean that you aren’t worthy of attention and care. Please find a counselor to help you sort all this out and get on with your life. You deserve to be happy again.

I wish you well.
Dr. Marie

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Depressed and Lonely

by Kristina Randle, Ph.D., LCSW October 24th, 2024
written by Kristina Randle, Ph.D., LCSW

Hello, and thank you for your time. Ok, where to start…i have an extremely hard time with girls, and I’ve always been a very lonely guy. I’m a good person, i have a good sense of humor, and I’m smart, but i always find myself alone, isolated, and lately I’ve been feeling suicidal. i just don’t want to be lonely anymore. i want a girl to hold, and who will hold me. I’m very uncomfortable around new people. I’ve been trying forever to step up and attract a girl, but my efforts always leave me with nothing. I’m twenty one years old, and the only girl I’ve ever been able to create a boyfriend/girlfriend relationship with was sixteen years old. i loved her with all my heart. i gave her everything i could. i got comfortable enough around her to reveal my true personality to her, and i got her to fall in love with my wit, charm, and creative talents. We spent a year and a half together, and she saved me. She was young, but she was smart and beautiful, and after being miserable for so long, I’d finally gotten someone to fall in love with me. She loved snowboarding and Mexican food and jelly beans. The year and a half was intense and extremely intimate because she connected with my feelings of loneliness and isolation. We were desperate for each other, we wanted to get married, to move to Australia, we’d even come up with names for the children we wanted to have with each other. Though her and my parents were extremely serious about trying to keep us completely separated, that only added to our intensity and desperation toward each other. Every night I would drive out to her place, and she would sneak out her window, and we would be together again. it was the best feeling in the world. It was the amazing feeling of love and connection and companionship i had been desperately longing for my entire life. We talked for hundreds of hours over secret phone calls. When it was too difficult or risky for us to talk, we kept a secret journal in which we would write about how much we loved and missed each other, and we would exchange it when we would meet. She told me I was her best friend. That I was the man of her dreams. That I was amazing and she promised she would never let me go. We told each other everything, our pains, our fears, our hopes, and we exposed our souls to each other. We lasted through some extreme trauma. Because of our age difference, when her parents found out, they hated me and put a restraining order on me. I completely understood how they felt, but I couldn’t tear myself away from the girl I loved. I just couldn’t. So we could still communicate, I would buy her a secret cell phone. Because her furious parents kept finding them and confiscating them, i ended up buying about seven total. Each time evidence of our communication was found, her parents threatened me more and more severely with jail threats, but I had to keep seeing her, had to keep talking to her, had to keep telling her how much I loved her. When my parents found out about the restraining order, they forced me to move from California to Florida with my grandparents for four months. While I was there, I cried and cried and thought about here every day. For four months, from the moment I got up at 3pm until bed at 7am, I sat at the computer with my guitar and mic and recorded love songs for her. I put them on the internet where I knew she could find them. I sent her a check so she could buy a phone, and we managed to sneak some phone calls. She would start crying as soon as she heard my voice, and she said she wanted to run away and get on a bus to come be with me. She said my songs made her cry every time she heard them. After Florida, I had to move to San Francisco for school. By this point, I had risked everything for her. My freedom, my future, my reputation, my heart, everything. I needed her, and she needed me. Two or three times a month I would be able to get on a bus and secretly go see her. The bus would drop me off in the dark of night, and I’d walk across the cold, silent town to our meeting spot. And there she would be, waiting for me in the moon light, the girl that made my tears run and my heart race and inspired me to go to school and make something of myself. She was the cure to my lifelong sickness that no medications or therapy or friends or parents had been able to help. She would jump into my arms and we’d both start crying, two fugitives finally together again. We fought so long and so hard to have what so many people take for granted. And then, suddenly last week, she called and told me that she didn’t love me anymore, that she was over me, and that she had found someone else. And that was it. I’ve heard about betrayal and heartbreak before in movies and songs, but this is more than I can handle. I’ve never felt so helpless, hopeless, and worthless in my life. I invested everything that I am in that girl, and after the most powerfully intimate year and a half of my life, I have nothing. I wake up feeling like I’m going to have a nervous break down. I cry uncontrollably. Our promises and our memories are eating me alive. I met the love of my life, and once again I’m alone in the world. All I can think about is how much I want to end myself. To get rid of this horrible feeling once and for all. I just can’t go back to this prison of agonizing loneliness. I believe that happiness is the only thing that makes life worth living, and now my happiness is gone. I understand that everyone i know, including her, would be shocked and devastated if I killed myself. She would blame herself, my parents would be torn apart, and my close friends would not even believe it. But why should I wait around and suffer for them? It’s such a sick paradox. If I live, the people that care about me are happy that I’m alive, even though I’m miserable. If I die, the people that care about me are miserable that I’m no longer alive and feeling miserable. But MY life is about ME. And I’m tired of being scared and lonely and wanting to crawl away and hide and feel like a miserable worthless loser. I’m twenty one now, and I’ve been unsuccessfully trying to stifle and defeat these feelings for ten years. Today I looked online at possible suicide means.

What I am concerned about is the intensity of emotion contained in your letter. You poured your heart and soul into making the relationship work. It’s fine to love and care for another person but what you described seems more like an obsession.

In fact, your entire well-being and functionality as an individual was dependent upon whether the relationship worked. You were happy when the relationship was going well but you essentially fell apart when it was over. It’s not healthy psychologically for your well-being to be reliant upon others. This is the heart of the problem. This is not a healthy way to behave in a relationship.

Ideally, your happiness needs to come from you. When it does you have control over how you feel. It also minimizes the chances of being hurt by the actions of others.

Counseling could really benefit you especially because you are considering suicide. It’s never okay to harm yourself because of another person. It’s possible that that the girl you were dating was not ready for an adult relationship. She was only 16 when you dated her. Developmentally, a 16-year-old may not be fully able to engage in a serious committed relationship. It’s also possible that maybe she was not the “girl” for you and in a year or two you’ll meet someone new. But if you decide to end your life you’ll never know what the future holds. Suicide is never the answer.

Counseling can help you learn a new, healthier way to behave in relationships. It can also help you learn how to be happy with yourself. If your happiness is dependent from others you will forever be at the mercy of the will and actions of other people. That is the worst way to live.

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Couple/family issue in relation to my bipolar & my meds

by Kristina Randle, Ph.D., LCSW October 12th, 2024
written by Kristina Randle, Ph.D., LCSW

Q. I know this is really lengthy, but I am in desperate need of help, my self-esteem is shot, and I am paralyzed with fear. I don’t know what to do. I wrote enough to set up the scenario and my history for you, to give you a better picture . I hope you *will* reply, I really need help.

I was diagnosed with BP1 in 2005. I have a long family history of bipolar disorder and depression as well. This is part of what led my dr. to this dx., along w/ other clues. I have worked with a good psychiatrist from the get-go to try to find a medication that works for me, and resolve some issues regarding the bipolar disorder.

Right now,I’ve been taking Lamictal for about a year, 200 mg. daily. It has taken a long time, but the dose I’m at now is helping more. It’s my opinion that I should try a higher level, since, while I don’t have the psychotic or manic symptoms as long, badly, or frequently, and the depressions are also not as long, frequent, or deep, I am still having “hiccups” so to speak. I am a rapid cycler who has mixed states as well. But it’s all starting to tone down a bit. With that established, here is my dilemma.

My husband of 20 years, who is a great skeptic of all things psychiatric, and believes meds are unnecessary, and that I am just looking to excuse my behavior with a diagnosis & medication, has recently began making snide comments and innuendos about my medications. He has repeatedly questioned, what is this? what does it do? This mostly began recently, when my gen. practitioner prescribed Darvocet for a herniated disc, and Relafen for my increasing arthritis (have had arthritis since age 36.) So, my side of the medicine cabinet has been filling up a bit. I was taking– Lamictal, Trazodone only as needed for insomnia & anxiety, Relafen, Darvocet on as needed basis, and two different antibiotics for gum disease and an infection. This began really bugging my husband, and the remarks began.

I have had trouble with bingeing on beer on occasion in the last three years, since my last breakdown (’04, before my diagnosis). I have been much better, allowing my meds to do their thing, and not running for a beer when stress hits me. It does feel better not to. I have a very low tolerance for stress, & we’ve had a LOT lately. Plus, I’ve been trying to find a job for two months, with no success, and feeling very low about this. I’ve been a stay-at-home mom for 16 years, and I think this is affecting my search.

T. and I had a blowout the other night, after I had finally had enough of his comments and his recent treating me like a five year old (to the point of even accusing me of *acting* like one.) Probably because of some financial issues I caused when manic and depressed two years ago (from which we are still recovering, & almost there), he has really been on my case about money & spending. Aside from some forgetfulness and my disorganized filing habits, I have let a bill or two escape payment, but I only spend what is needed for the household, the kids, or whatever unforeseen thing that may come up. I am not a “big spender” or an “impulse shopper,” I have no “shopping addiction.” However, he recently started questioning every penny I spend, and I then have to account for EVERY penny.

He took a loan out against his 401K last week, so we could — together — catch up the last few late bills. He called me immediately and told me sternly “DO NOT spend ANYTHING until we can sit down and work the budget out together. I do not want to blow this money. DO NOT go to the bank or the store!!” He repeated himself a couple more times, and I assured him I wouldn’t . He made such a big deal of it, and even when he got home. Well,I finally had reached the breaking point, and sent him a sarcastic email asking permission to buy these items, and saying he’s right, I’m a child and must be monitored at all times. I wasn’t very nice. Our blowout the night before had been a yelling match in which he had the upper hand, and shot down *anything* I tried to say with “Oh, here we go again — the ‘woe is me’ crap from you!” “Oh, THAT’s appropriate behavior for a five year old!” and similar things. I snapped, and went to bed crying myself to sleep.

I am tired of this. In my email, in my anger, I also said angrily, fine, I am quitting ALL my meds — the back pain meds, the psych meds, ALL of it — since he so disapproves of my “drug use.” Well, I realize, that’s stupid (although tempting) and now I want to just tell him, You know what? My search for stability is important to me AND to this family, and I have decided NOT to quit after all. I’m sorry if you disagree, but I feel this is what I need to do. The back pain med was prescribed to help me avoid surgery for as long as I can, since we have kids and horses, and financially, surgery and my layup would not be a good option for us.

So, I am not sure what to do now. There are also some issues he has with jealousy, and thinking I’m cheating or sneaking around — he checks our emails constantly, asks me “Who’s this? What’s that?” and gets really mad when I forget and leave my cell phone at home or in the car & he can’t call me. I’ve done nothing to warrant his behavior. I’m tired of being monitored like a child or a criminal. But that’s a whole other issue! Mainly, I am scared to stand my ground at this point, & take back what I said, and stay on my meds. My back is already hurting me *a lot* after three days, and I’m still on my Lamictal, only at a tapering off dose in spite of my p-doc’s recommendation.

I really want to talk to him, but i’m afraid he will turn it all around to make me feel bad about it. By the way, please don’t suggest marital counseling. We’ve already done it twice; he turned it all on me, saying everything was my fault, and thinks it’s all a crock anyway. He won’t go again. I am desperate, and feeling belittled, and have little self-esteem or confidence here. I really need some help or encouragement. I hope you will reply. Thanks for reading anyway.

Thanks for your detailed letter. Of course, you should stay on your medications. It sounds like you have finally found a regimen that works for you and you have done this in tandem with your doctor. Many people struggle for years to find a medication that helps regulate their symptoms. Also, many people find it difficult to find a doctor that they like to work with. You have both, a good doctor and medications that work for you; it would be foolish to forgo what is working.

If your husband does not understand why you are taking medications, or why you need them, perhaps you can inform him. Have the two of you sat down and had a real “heart-to-heart” about what it is like to live with bipolar disorder? Have you communicated with him precisely how the medications work for you? I know this seems like common sense, but maybe, being that we all seemingly live busy lives, these basic facts were never communicated to your husband in a way that makes sense to him.

Also understand that many people do not understand bipolar disorder and this can and often does include family members. Some family members find it difficult to believe that their loved one has the disorder, as in your case. This may be due to ignorance about bipolar disorder. Bipolar disorder is difficult to fully understand. Some family members, this may be true for you as well, are angry at their loved one for being “sick.” It is human nature for this to occur and very common. It does not make it right to be angry at a loved one for being ill, but it does happen. It is likely that your husband is at the very least not informed about the disorder.

I know that you do not want me to suggest marriage therapy and that’s fine, although it is necessary and with the right therapist, you could have had more success.

I am going to suggest individual counseling for you. It is also clear that your husband could benefit from individual therapy but it does not sound like your husband is open to the idea. Even if he is unwilling to get counseling, you still should.

I am suggesting individual counseling for several reasons. The first reason is because you could use some guidance in helping you build your self-esteem, and this can be done with a therapist. The second reason is that you (and your husband too) could benefit from working with a therapist on your relationship issues, and here are a few examples of why:

Your husband yells at you and you feel like a child. There is something clearly wrong with how he treats you. In this case, he is in the wrong.

He hounds you about taking medications; medications that seem to be helping you. Again, he is in the wrong.

In the last fight that you wrote about, he tells you that he wants to save money to pay the bills, asks that you not spend any money and you reply inappropriately, as you already know, with a sarcastic letter, egging him on, and a statement that you are going to quit taking your medications. In this specific case, you were in the wrong.

Your behavior (as well as his) within the relationship needs to be analyzed. A therapist can help you analyze how each of you behave within the relationship and help you correct your behavior and help you see how the both of you contribute to your “blow outs.” Every fight that occurs between the two of you hurts and damages the relationship. And that is why a therapist, even if it is only you that attends, is very important in your situation.

I hope this helps answer your question. Take care.

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Suicidal friend in an abusive relationship

by Dr. Marie Hartwell-Walker August 28th, 2024
written by Dr. Marie Hartwell-Walker

Two summers ago I was a counselor at a self growth/leadership camp. One of my campers started calling me at the beginning of the school year last year with boyfriend issues. It didn’t seam like that big of an issue at first, but it got so bad she’d be on the phone with me crying till 4am. I tried getting her to go to counseling or get help somewhere where someone will know how to handle her situation better but she wouldn’t. It’s been over a year now and for the past few month she’s been calling me or talking to me online at least once a week, sometimes more. She sees a counselor once every two or three weeks but she says it isn’t helping very much. Her boyfriend treats her terribly and is always yelling at her and telling her if she loves him she would change and she would control her emotions and grow up. He yells at her and tells her she’s stupid and fat and ugly and she doesn’t deserve to have friends. He tells her about other girls and parties and stuff and that he doesn’t want to be with her anymore. She says she loves him and can’t be without him. He’s made her so upset she’s tried to kill herself twice in the past semester. She calls me crying and telling me she doesn’t want to be here anymore and I feel so helpless. I’ve given her several numbers for suicide hotlines and counselors in her area but she won’t call them. I’m afraid if I can’t answer my phone to talk to her she might do something and I know I’d feel responsible for it. I don’t know what to tell her anymore…

You’re absolutely right. You are way, way over your head. It’s not at all unusual for a therapist to say at the outset of treatment that everything is confidential except when someone tries to hurt themselves or talks seriously about hurting someone else. We want to make it clear that in that event the rules of confidentiality are off and we will take action. Saving lives takes priority over keeping secrets.

Your camper is underage. You are not a professional therapist bound by professional rules. I therefore strongly urge you to call this girl’s parents and turn her care over to them. Tell them what your camper has told you about the boyfriend. Inform them that she says the counseling she is getting isn’t helping her. As difficult as it will be, tell them that she has told you that she has made two suicide attempts. It may or may not be true but even making up stories about attempts is concerning. They deserve to know how serious the situation really is.

Then let the parents take charge of helping their daughter. Don’t, don’t, don’t feel guilty for taking action. Yes, she will blame you and will tell you that you have betrayed her and abandoned her. She may say that but it isn’t so. It’s a much bigger betrayal for you to go on trying to be a therapist when you have neither the training or experience to be effective. By talking with you, she is avoiding dealing with her issues with her therapist. You need to get out of the loop. If she contacts you, keep it short and to the point. Tell her that you do care. Actually you care so much you want her to get real help instead of the minimal help you can offer. Don’t get into an argument about it. Just let her know that every time she calls you, you’re going to inform her parents. If she keeps it up, tell her and her parents that you won’t respond anymore.

Therapists all have supervisors just for situations like this. We need support to keep our heads clear and to do what is most useful instead of what a desperate person demands. It’s hard to say no when someone is so upset. It’s hard to pull back if someone says you’re the only one who can help or that she’ll hurt herself if you won’t continue to be there. If you think you can’t extricate yourself, it would be advisable for you to see a therapist to act as your “supervisor” for this case. You’ve done the best you could. Now it’s time to let the experts take over.

I wish you well.
Dr. Marie

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How Do I Help My Daughter?

by Kristina Randle, Ph.D., LCSW July 20th, 2024
written by Kristina Randle, Ph.D., LCSW

About 6 months ago I found out my husband had been having suicidal ideation for about a year. I thought he was having a lot of work related stress and had no idea how bad he was because he managed to be highly functional despite his depression. Depression and suicide runs in his family. Shortly after that I found my 16 yr old weeping and stressed a few times. A year ago one of her acquaintances committed suicide and two of her friends have been depressed and are now being treated for it. She was in constant fear that someone else was going to die. Fearing she was also in trouble I got her into therapy. As her father and friends have improved with medication and therapy, it seemed like my daughter had improved, but neither her and I have felt like her therapy sessions have had much impact. She is very shy still with her therapist. Tonight she broke down and was crying again. She is very imaginative and says that she wishes she lived in the fantasies she imagines and is disappointed that she can’t. But sometimes it feels like they are real. Real life is boring. She can’t stand being around most people and large groups of people make her feel very anxious. She feels irritable around her family and feels like being mean to her siblings and harps on them. She hates feeling like she is a mean person, but can’t help it. She is often disrespectful to my husband and I and doesn’t care and feels guilty that she doesn’t. A couple weeks ago she was mad at us because we wanted her to do her chores and she stormed out of the house and was gone for a couple hours before returning. It scared me, but we just treated it like she retreated to her room for a bit, because we didn’t want her to using running away as an attention getting thing. She was interested in writing but no longer wants to because she is discouraged that she can’t write out what she can imagine much better. She knows she is being too perfectionistic about it but can’t get past it. I also think she feels low self esteem because although she is very bright, imaginative and enjoyable to be around she compares herself to others, including her siblings, who have talents that are more easily seen such as being in the gifted program, music or athletics. She was a very outgoing, fun child but is much more reserved and insecure as a teen, at least outside of the family. She says she thinks something is wrong with her. She sleeps fine, no weight or diet changes and had straight A’s. She doesn’t want to go to her therapist anymore or start over with anyone else. I don’t know if she is just going through normal growing pains or if she really needs more intervention. And my recent failure to see my husband’s needs makes me not trust my own judgment on the matter. I just want all my family to all be happy again. What can/should I do to help her?

Between your husband’s recent suicidal ideation and the suicide of one of your daughter’s acquaintances, the fact that she is reacting to these circumstances is normal, but professional intervention is required. Some research suggests that suicide can be contagious, especially among teenagers. One person’s suicide or suicidal ideation can trigger another person’s thoughts or behaviors. Though she has never directly expressed suicidal thoughts, her risk of suicide is elevated.

You felt that her therapy was not helping but was it given a fair chance? Your daughter improved but you allowed her to quit because she was “very shy with her therapist.” Shyness is not uncommon in the beginning of therapy. It takes time to build a trusting relationship. She should return to therapy. Try another therapist. We are not all the same.

If resuming therapy is not an option, then you should contact the therapist, report that your daughter refuses treatment but clearly needs it and ask for help. The therapist is familiar with her case and can advise you about how to proceed.

Given your daughter’s exposure to suicide, she may be more susceptible to suicidal thoughts or behaviors than someone without exposure. Your daughter should be in treatment.

If you continue to struggle to help your daughter, then you should consider entering individual therapy. Family therapy is also a wise option, especially given your husband’s suicidal ideation. If you attended therapy, you would serve as a great role model for your daughter. If she sees that you are willing to engage in treatment, then she might follow in your footsteps. Do whatever is necessary to ensure that she receives help. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Intense Feelings Cause Worry

by Kristina Randle, Ph.D., LCSW June 8th, 2024
written by Kristina Randle, Ph.D., LCSW

Since I was in high school I have suffered from depression. I always thought so little of myself and how can others possibly like me? I kept few friends and had quite a few boyfriends. I had a boyfriend for about 7 years. I always had this intense feeling that he was cheating on me when he was not with me. Deep down I knew that he wasn’t, as he loved me dearly. But I couldn’t shake this feeling. We had sex pretty early in the relationship, he was my first partner. I found out after that I was not his first and I felt betrayed. After that I went on to cheat on him several times, sleeping with a few different men, just one night stands. I didn’t think clearly, I didn’t even protect myself. Luckily through all of it I didn’t get pregnant or contract an STD. My partner put up with me for all those years knowing that I had cheating on him, thinking that I could be a better person. But I just couldn’t see myself as a good person.

Eventually after losing my job, I sat around for months not doing anything. He left me stating it was for my own good and I needed help. He still loved me, but he wanted me to get better. Years later I am now married to a wonderful guy. But I still get these intense feelings about things that should not matter. Such as, he likes a photo of a female celebrity on facebook. I get furious with him. Again, deep down I know I shouldn’t feel this way, but I can’t help it! When things are going great I feel so connected to him and want to feel that way all the time. But something so little just makes me snap and hate him. I don’t want to feel this way, I know it’s irrational. But I don’t know what to do.

I have always reacted very strongly to things. In school when I would get in trouble, sent to detention. I would start crying because I felt like scum, I felt like I was this worthless being. When I would make a comment to someone and they took it bad and hurt their feelings I would feel like I needed to punish myself for it. Sometimes by cutting myself, once with a broken bottle I found nearby. Even now at work, if I get in trouble for something that isn’t even that bad, I feel worthless, like I don’t deserve to live.

I can’t stand living with these intense feelings anymore. I want to be happy, but I feel like I don’t deserve it.

Your intense feelings might stem from jealousy. Individuals who experience jealousy are insecure. This insecurity comes from a lack of confidence. Jealousy is ultimately the lack of self-esteem. In relationships, it can be severely damaging. Jealous individuals see others, and in your case pictures of others, as being a threat.

You described yourself as being highly sensitive and there are times when you feel as though you are a “worthless being.” You also feel the need to punish yourself when you do something wrong. It’s also concerning that you sometimes don’t have the desire to live.

At the core of these issues may be depression. Individuals with depression do not think highly of themselves. They often see themselves as being unlovable and unworthy of love. They minimize their positive attributes and maximize their negative attributes.

These problems can be easily corrected with psychotherapy. Depression is highly treatable. Millions of individuals deal with self-confidence problems and have had great success with psychotherapy. I would highly recommend it. Please take care.

Dr. Kristina Randle

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I am so very confused

by Dr. Marie Hartwell-Walker June 2nd, 2024
written by Dr. Marie Hartwell-Walker

I am not really quite sure about where or how to start this off because “I” believe that there may be other factors than just depression going on, but I am not even sure if I really have it or just hoping that I do so I can finally have an answer for why I feel the way I do.

I will go ahead and start off with a brief description of my past to also aid you in helping me out. As a young kid and up through elementary school I was quite shy. Although this would seem usual for younger kids to me it just seemed to, well, get in the way of making friends or just being a kid in general. I felt more comfortable in my room watching TV or playing videogames by myself rather than being around anyone. I made a few friends here and there but looking back on it, it just doesn’t seem normal. From high-school and up until I was turned 20 things became worse to say the least. More time spent alone by myself doing things and I didn’t go out much at all so I just seemed to gain weight all the time. My self-esteem was rock bottom and self-hate just seemed to radiate from me. The ability to be able to socially interact and make friends seemed to worsen and the few I had would at times become abusive physically and mentally, I seemed to just serve as an example to others. This only further cut deeper into the depression, alienation and antisocial behaviors that I seemed to have. This increased to the point of self-mutilation and lots of thoughts of suicide. This of course was in my late teens and was unsure at the time about how to handle depression and that is all I knew. Eventually my parents caught on and I was taken to a doctor and prescribed anti-depressant medication but eventually stopped taking them. Reaching 20 years old I just seemed to become so disconnected and out of sync with reality that it started to cause real problems with family and what friends I had. Things eventually clicked in my mind and I had an extreme desire to change myself physically and mentally. Going out, going to the gym, starting college, trying to make friends…etc.

While I have dramatically changed from those three years ago when I began. I still feel mentally tortured day to day and at times it gets so extreme I cry myself to sleep. I do a lot of online reading and am taking psychology classes in college in hopes of just being able to understand these things. Although I am unsure if I am making myself believe I have these problems or if I really need to seek help.

I haven’t made the effort yet to talk to a doctor yet because I am really unsure where to start or where to go and I don’t really have the money. I don’t discuss these problems with friends or family because I do not believe they understand. While not every waking moment of my life is torture I would say about 3/4 of the time things are just dull and empty. Happiness doesn’t seem to exist, I almost never smile or find the want to. I easily lose interest in activities and other things that I have enjoyed in the past. Sadness is quite common and am easily pushed emotionally in one way or another. Crying episodes seem to happen quite often as I feel so very lonely, worthless and angered at myself for my failures in the past. Which sometimes become so extreme that I cry myself to sleep some nights. I feel out of energy and can’t ever seem to completely wake up as it feels like I am in a dazed mood all the time. I also at times find it hard to concentrate, especially when I am feeling really down. There is also times that I just do not want to talk to anyone or go anywhere at all, which I believe I am in right now. For an example, today was my birthday and I turned 23. I just really didn’t care that it was my birthday, if I went the entire day without anyone saying or doing anything I wouldn’t of even cared. I didn’t even make any attempts to go out with any friends or to even celebrate at all. I just feel empty and can find no happiness or joy in life.

Although depression is the main issue I believe other factors might as well contribute. While I have made an effort to help myself I still have a rather hard time socializing. I often at times get anxious and stressed in social situations. Especially around those I don’t know and even at times I feel anxious and stressed around my own family members. I have always found it hard to socially connect with anyone at all or finding something in common or even being able to indulge in small talk. I am very shy and most of the time short with people and often feel it might of been better if I just hadn’t even made the attempt to talk to anyone. After reading around it seems that there is a chance I have social-anxiety and if I remember correctly can attribute to depression?

Lastly I have led myself to believe there is a chance that I might be bipolar. The reason for this being is that it seems that I have large mood swings every month or two. This past November and December I slipped into bad depression and continued to stay depressed up through the beginning of January. Then my mood took a swing the other way and it was very uplifting as for once as I actually felt happy and things were going the right way. Although the end of February I believe I began a decline again and as of today I have began hitting a low point again it seems.

I am unsure of any of this as things seem so scrambled most of the time. But I am sure of one thing and that is that I want this mental anguish to end because it is really taking a toll on me. I also suppose I should put forward the fact that I do now and have in the past drank alcohol, smoked marijuana and took painkillers to just get away from it all. I find myself saying this a lot…but I just want to be normal for once. These problems are driving me out of my mind and I just want it to stop. I am unsure where to go, who to turn to or what to do. But I have got to start making steps I believe or I am going to lose control. So for whoever attempts to tackle this, thank you. Thank you very much for at least trying to help me make sense of it all.

Hello. I’m so glad you wrote. I hope I can help you out of the spin you’re in. Your letter is an excellent reflection of your state of mind. People who are in distress or depressed often ruminate – meaning that they go over and over and over the reasons they feel bad, the possibilities for why, the many reasons why it’s hopeless, and the equally many reasons they are helpless to change it. You are spending hours trying to figure out what is wrong with you and tracking the history of your feelings. Enough already. You are only going around and around and around and not finding a way out – which only makes you feel worse.

I can’t make a diagnosis on the basis of a letter, of course. I suggest to you that at this point it doesn’t really matter what the label is. You feel terrible. You can’t figure out how to make things better. You do want a better life.

Please. Give yourself the respect and caring you deserve. Find yourself a therapist. Most colleges have a mental health center where you can at least get an evaluation and a referral. It doesn’t fall on you to have a diagnosis in hand before you talk to someone. That’s what they are trained to do. It doesn’t matter if you don’t know where to start. A therapist will know how to elicit information from you that will help you both understand you. It doesn’t matter that you don’t have much money. Many mental health centers and private therapists have a sliding fee scale to make therapy affordable. Your college may have clergy who provide pastoral counseling for free. You can also make a start by talking online with a counselor at the Boys and Girls Town National Hotline at 800-448-3000.

If you could have stopped the spin on your own, a smart guy like you would have done so long ago. I hope you will now reach out to get the help you need. You’ve suffered much too long.

I wish you well.
Dr. Marie

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Mood Swings and Depression Caused By Birth Control?

by Kristina Randle, Ph.D., LCSW May 28th, 2024
written by Kristina Randle, Ph.D., LCSW

I have a few questions about mood swings, depression, anxiety, etc. First, the background: I have been taking hormonal birth control pills for 16 years. After the first 3-4 years I began having terrible mood swings; I would cry over nothing, develop into a rage that would simmer for quite a while, and occasionally throw things and punch walls and pillows. I talked to my doctor about it and he put me on an antidepressant. First we tried Paxil, but it made me dizzy and it also made my sex drive vanish. Then we tried Effexor XR and I felt better almost immediately. Years later I thought that maybe my brain chemistry had changed and I tried to go off the Effexor but it was horrible to say the least. I had brain shocks, terrible headaches where I couldn’t even move my head, and I was back to the crying and rage behavior. I was also in bed for a solid week with the symptoms. I was so miserable that I went back on the Effexor and now I feel fine again. My question is this: Could all these issues be related to being on the birth control pill for so long? Did I maybe only need the Effexor to handle the side-effects from the birth control? I’m also worried that I have irreparably damaged my brain with these chemicals and will never be the same off them. I’m wondering too because my husband and I would like to have a child within the next 2 years or so, and of course I’ll need to be off both meds by that time. Also, I’d really like to stop putting all these hormones and toxins into my body on a daily basis.

The only way to know if the moodiness is being caused by the birth control pills is to stop taking all of your medication. I am not recommending that you do this, especially without the assistance of your doctor, but it may be the only way to untangle the truth.

It is difficult to determine a cause and effect relationship between the birth control pills and the moodiness. Moodiness is a common side effect of birth control. It is very possible that if you were not on birth control you would not need the Effexor. It may also be true that your brain chemistry has been altered because of the birth control, although that would be very difficult to determine. The only way to know that information would have been to have taken a chemical or hormonal reading before and even then there would likely be no clear answer.

I would recommend speaking to your doctor about this issue. Perhaps you are not taking the correct type of birth control pills. Given the fact that you had such a strong reaction to them, alternatives should have been explored. A different type of birth control may have had an entirely different and more positive effect on your mood.

It might also be helpful if you met with a professional therapist for assistance with the moodiness. He or she might be able to determine if your mood swings are related to the birth control or part of an underlying personal struggle or mood disorder. I would especially recommend seeing a mental health professional when and if you decide to discontinue the birth control and antidepressants, to have children. During that process, there will likely be a psychological adjustment that you will go through and having a therapist to assist you during this process is advisable. If you would like to search for a therapist in your community, please consult this directory. Thank you for your question.

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Early Menopause?

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP May 20th, 2024
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

After about six months of going to doctors and more doctors to try to find an explanation for some strange physical symptoms I have been having, I was recently told that I am very likely to go through menopause in the next two years or so. As a 26 year-old who recently finished a master’s degree and just finished my first year in a job that I love, this news was not only surprising, but also devastating. I’m single, have always been healthy, and haven’t really given much thought to having children yet. Now I’m faced with decisions that I feel completely unprepared to make. I have talked with my doctors who have suggested that I look into freezing my eggs (sooner rather than later), fertility clinics who have overwhelmed me with information about the process of retrieving, storing, and freezing my eggs as well as IVF, and friends and family members who all have opinions of their own.

I have spent these past few days reflecting, weighing my options, praying, crying, trying to listen to myself, and trying to make some sort of decision about whether or not to go through the extremely expensive process of saving my eggs, knowing that the success rates are low. I do not know whether I want to have children. I know I’m not ready to have them now as I am starting a career and figuring out who I am, but what if I want them in five or ten years? I know adoption would be a possibility–and I know that I could love an adopted child as if they were my own biological child.

I went from living my life in the present a few weeks ago to being rushed into the future. I suddenly have doctors asking me how I would feel about having a child in the next year or so (which I’m not ready to do) or how I would feel about freezing my eggs (or fertilizing them and freezing the embryos) or how I would feel about never having my own biological children. I’m overwhelmed with such big questions, and I feel completely unprepared to make these decisions.

I see a therapist regularly, and she and I have begun to talk through my options and all of the pros and cons. It feels like there is no “right” or even “good” choice. The more information I gather, the more complicated and confusing everything seems. I am leaning toward letting my body do what it is going to do naturally and to later adopt children if I choose to do so, but I’m afraid to commit to that decision, because I know it comes with deep grief, sadness, and potentially irreversible consequences. No matter how much I obsess about this or learn more about the process, I don’t come up with a decision I feel good about. How am I supposed to go about making such a decision?

Your situation moved me deeply because your thoughtful nature and awareness are so keenly attuned to the dynamics of your situation. I hope I can offer a perspective that can be helpful.

Dan Gilbert is a Harvard psychologist who studies how we think about the future and try to predict what will make us happy when we get there. I am reducing his immense body of work to a few sentences which could not possibly do it justice, but in essence he explains that we don’t do a very good job of predicting what will make us happy –that we are more or less over-influenced by the present moment and that causes us to make systematic errors in what we think will make us happy down the road.

What tends to be true is that our happiness and what brings us a sense of contentment comes from having the courage to face our life circumstances directly. When we can accept our challenges and joys that are hidden in our life circumstance with an open attitude then we take our life and turn it into a work of art.

Stay with yourself. Stay present with your mind and your body. You already have a trusted therapist and a team of doctors. It seems to me the work is to stay present with yourself and don’t lose these moments of your life to indeterminate futures. What I am encouraging you to do is cultivate a mindfulness meditation practice. Notice where your mind takes you. Here is more information about mindfulness.

The shift is toward self-acceptance and believing that you will be okay with yourself regardless of what you decide.

Wishing you patience and peace,
Dr. Dan

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Why are suicidal thoughts returning?

by Dr. Marie Hartwell-Walker November 24th, 2023
written by Dr. Marie Hartwell-Walker

from New Zealand: Two years ago I became very anxious and suicidally depressed. I attempted suicide 3 times, the last time while hospitalised. I am ‘lucky’ to be alive after a fairly lethal attempt. Prior to that I had no psychiatric history.

I now realise that I was in an emotionally abusive relationship. My husband was very depressed, emotionally disturbed (I believe from some childhood experiences), and also suffered from a mild traumatic brain injury that occurred just after we were married 13 years ago.

A year ago I separated from my husband. It relieved the tension on the children (5yrs, 8yrs, 10yrs)and myself. We had all felt like we were walking on egg shells around him and his anger was getting out of control. He had stopped working because he could no longer cope and he became quite fixated on me and more controlling and overtly verbally abusive as well as shoving me a few times.

It was an extremely difficult decision to give up a cherished ideal. I see my husband’s pain and loneliness and I feel terribly guilty and sad for him. I had thought I would go back after a period of separation but just thinking about it fills me with anxiety. He is the most charming man and the most hurtful man I have ever known. He professes profound love for me and I feel he puts me on a pedal stool but then quite swiftly changes to calling me the most nasty things and ignored me for much of our marriage. When I see the good side of him I think maybe we can work things out but when I seriously contemplate it I feel a sense of doom. Mostly I cope by not seeing him at all. I have gone back to work as a registered nurse part time and my life is getting back on track.

Mostly things are going well – on the outside at least. I never thought I could face work again in a hospital after becoming a psychiatric patient but have got over the stigma. However for some reason every now and then I feel like I’m falling off the edge again and it frightens me intensely.

I am feeling very fragile right now – tearful and sad. Good things happen and I feel ok but it just doesn’t last. As soon as work is over my brain tunes out again. I drive in the car and feel like crying for no reason. I have that butterfly feeling in my stomach back. I have not been able to sleep properly since the original episode of anxiety and depression. I feel tired all the time, I can’t sleep, and if I didn’t have children I simply would not get out of bed. Another strange thing is that I haven’t been able to read for pleasure for the last two years. I can not settle to read a book but I can read something I have to for work. Previously I loved reading and would always have a book(or a few)on the go.

Can you help me to work out why this is happening now? I have a craft knife of surgical sharpness which I have left at the top of my wardrobe for the last year because I fear myself with it. I honestly bought it for cutting tiles (I have made tile mosaics in the past and thought I would get back into it). I have lived with bouts of suicidal thoughts occurring every couple of months or so for the last couple of years but thought it was over now. They have been less and less intense. I worry that I won’t be able to work and support my children and if I go crazy when I am employed I’ll never have a career again.

Just to clarify: I do not fear for my patients, I fear not being able to work because I get so immobilised by depression, and all my colleagues would know and I would not be able to return. When I went quite crazy I didn’t realise what was happening to me – I’d always coped well with many various difficulties. It was a shock to realise that I had been very much in denial of my feelings of sadness for a long time. I am 44 and used to think I knew some stuff about life. Everything I believed has been shaken as I thought I was doing the very best thing for my family when I went mad.

If you have any insights I’d be grateful to read them. Thank you.

Once someone has been seriously suicidal (or been close to someone who has suicided), ending life becomes more of a real option. You’ve already faced the prospect of death and decided several times that your misery in life outweighed whatever fear you had of death. The fear of the unknown of death is an inhibitor to suicide for most people. It’s not there in the same way for you. (The same thing happens for some people when they survive a life-threatening illness or accident. Death just isn’t so scary any more.) There is a kind of peace that comes with that but it also puts you at more risk.

With all you’ve been through, it’s not too surprising that you’ve developed a sleep disorder but it certainly isn’t helping things. Sleep deprivation makes people feel fragile and vulnerable. My guess is that it takes all the strength and concentration you’ve got to hold it together all day at work. Of course you fall apart on your way home. It also makes sense to me that you can’t read for pleasure. By the time you’ve taken care of your patients and your kids, you’ve about used up your ability to focus for the day.

That you even entertain going back to a husband who demonstrates signs of being a habitual abuser worries me greatly. Although this is common among wives who’ve been on the emotional roller coaster of an abusive marriage, it does suggests that you still have some important work to do in therapy.

You said you have been hospitalized. You didn’t mention whether you have had follow-up care. Continuing in therapy can help you work through your feelings of anxiety, guilt, and pain and will help you regain your self-esteem and confidence. You would probably also benefit from attending a support group for abused women or using one of the chatroom support communities.

Please give yourself lots of credit. You’ve managed a job, kids, and your own inner turmoil for a long time. You’ve done it in spite of little sleep and lots of worries. You have a core of strength that maybe you didn’t know you have but you’re getting worn out. Regular, professional help will give you the added support you need until you replenish yourself. Write me in a month or two and let me know how it’s going.

I wish you well.
Dr. Marie

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Refusing school and crying hysterically

by Dr. Marie Hartwell-Walker September 11th, 2023
written by Dr. Marie Hartwell-Walker

For almost a month now my 11 year old nephew is refusing to go to school. He will complain of a stomache ache or sore throat and cry hysterically. He will refuse to get out of the car. My sister has taken him to the pediatrician several times and they find nothing wrong. There have been 2 episodes where he curls up in a ball and cries and says please help me. He doesn’t understand why he doesn’t want to go or what is wrong. She has talked to school counselors and was told to take him to the crisis center. She did that and was given a referal to a Psychologist but can’t get in any time soon. He has missed so much school. He never came home with any signs of bullying. He has always loved school and gets great grades. She is worried he could have been sexually abused while at school.

Your nephew is a lucky boy to have the mom and aunt he has. Something is very, very wrong. I don’t know if he was sexually abused but his behavior is of a frightened boy. He may be unable to tell you what happened to him because someone threatened to hurt him or his family if he did. Another possibility is that he is ashamed. And there’s always the possibility that he doesn’t know what is wrong. Although the pediatrician has cleared him, something may still be amiss.

To probe a little: His mom could try gently telling him that some secrets are not secrets he needs to keep; that the adults will protect him and themselves if he tells them the threat. She can also tell him that sometimes people are forced to do things they are ashamed of but that it isn’t his fault if he was threatened or forced or confused. Finally, she could share with him that sometimes people have disturbing thoughts and that she is willing to hear them if he wants to get them out. Short, quiet, loving conversations are most likely to be helpful.

He is asking for your help, both in words and behavior. The best gift you are giving him is that you are showing him that you believe him and you’re trying to get to the bottom of it. By not forcing him to go to school, you are showing him that your first priority is his safety. That’s an important message right now.

It’s hard for me to believe that there isn’t a child psychologist within 100 miles of you who has an opening. Please intensify your search. The longer he sits with this distress, the longer it will be for your nephew to recover from whatever is troubling him.

Meanwhile, missing a month or two of school is small price to pay for his psychological health. If he had pneumonia, you wouldn’t think twice about keeping him home to help him get well. Once this is over, a tutor will help him catch up. A smart and motivated kid can whip through a semester of school in only a couple of months.

I share your worry about this little boy. I hope you will make every effort to get him appropriate help as quickly as possible.

I wish you all well.
Dr. Marie

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My wife had an emotional affair.

by Dr. Marie Hartwell-Walker July 26th, 2023
written by Dr. Marie Hartwell-Walker

I recently discovered my wife was having an affair with a co-worker. She swears they did not have sex, but the day I discovered this, she was with him the entire afternoon and they had planned on meeting at a local hotel. It has been 3-months since I confronted her and she swears there has been no contact with him since that time. We have been attending marital counseling, but everytime she leaves the house, I am worried she could be secretly meeting with him again. When I initially confronted her, she lied numerous times, telling me he was just a friend, then later admitted he loved her, she loved him, they had even kissed right in front of our home on occasions when he had given her a ride home from work. She changed her story regarding him so many times, I don’t know what to believe and I don’t trust her at all. Our sex life has always been great and she says the relationship sort of just happened. I am in great physical shape and very attractive. I have never given my wife a reason to be jealous and spend lots of time catering to her. I make 3-times as much money as she does and shower her with many gifts; we travel, spend romantic evenings together…what ever she asks for. Now after 16 years of marriage, she tells me she feels inadequate and has always felt I would just up and leave her one day even though she admits I have not given her a reason to feel this way. She has recently been screened for depression and has shared with me her constant unexplained bouts of crying. I am very angry with her as I never thought I would put up with something like this…How can I stay with her when there is no trust. At this point, the main reason I have not left is because of our 12 year old son. I want him to continue having both parents under the same roof…I want to work it out, but I can’t get past what she did…

It sounds like some good things are beginning to come out of your marital therapy. Your wife is sharing long standing problems with you, maybe for the first time. Apparently, she has felt insecure in your relationship for years and you have been oblivious to her fears. It’s sad that the only way she felt she could tell you (and perhaps herself) that your marriage is in serious trouble was to create a situation where she would be “caught”. It took a crisis to get you two into therapy where you could begin to really communicate. Focussing only on what she did will keep you stuck. Please work with your therapist to develop more understanding between the two of you, to help your wife with her depression, and to help you be more sensitive to her emotional needs. Sixteen years of history and a 12 year old son are more than enough reason to do the hard work required to get to a new and better place in your relationship.
I wish you well.
Dr. Marie

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Depressed and Need Help

by Kristina Randle, Ph.D., LCSW July 15th, 2023
written by Kristina Randle, Ph.D., LCSW

I am depressed, lonely and feel unable to reach out for friends. I have a history of depression from my teenage years that was treated with medication. I am 23 and have quickly sunk into a depression. My mother has been dealing for a few months with cancer and she has always been my rock, but now she has no attention to give to me and naturally everybody else in my family is focusing on her as well.

I had lost my job and dropped out of this semester of grad school because i felt too overwhelmed to handle class and work and my mother… I also have been living 60 miles away from my friends and have no friends where i live.

So I am lonely as can be, far from the few people that might offer me love. I have not told my parents that I lost my job or that I am so sad, all because i feel guilty taking attention way form my mother or making her feel bad. Last week I was so sad that I just started crying on the sidewalk as my roommate was talking to me.

I have had nobody to share my pain with and it’s so hard to reach out. I have been staying in bed till noon and watching TV all day, just trying to hide from the world.
I am so depressed. I need help. What do I do?

I’m sorry you’re dealing with a difficult situation. Having a close relative with cancer has to be difficult, especially when that person served as your main support. I know that you don’t want to ask for help and support but that is exactly what you need at this time.

You assume that you’d be a burden on your family but I doubt that would be the case. It’s not uncommon for people with depression to feel like they are a bother to other people. If you reached out to your family and told them about your depression there is a good chance they’d respond in a supportive way. You may even find that they are also having a tough time trying to cope with your mother’s diagnosis. You could lean on each other.

Even though there is a good chance your family would be supportive of you if they knew about your depression I think it would be helpful if you sought additional supports outside the family. The additional support could either be a support group or an individual counselor. Both might be necessary. The reason I am suggesting that you find support outside of your immediate family and friends is that it may be difficult for them to give you the full attention that you may need at this time. Also you described having fairly serious symptoms of depression. Your friends and family may be able to offer you some support and that is good. But given the extent of your depression (i.e. you’ve already quit school, are struggling with work and spend half the day in bed) there support alone may not be enough. Your depression symptoms may require professional treatment.

There are many great support groups for individuals who have family members with cancer. Some of the support groups are web-based. There are also many in-person support groups that allow you to interact with others who have relatives with cancer. Both may be helpful to you. A list of possible online and group supports can be found here.

It makes sense that you would be having difficulty at this point in time. Your mother was diagnosed with cancer. You lost your main support system and in turn, you’re finding it difficult to function day to day. I know it is a challenge but try to reach out for help from support groups and/or a mental health professional. You need to do this not only for yourself but for your mother who most likely needs you to be her “rock” while she is battling cancer. Be there for yourself and be there for your mother. You can’t appropriately assist your mother until you help yourself. Don’t give up and please consider outside help for this very difficult life circumstance. You need and deserve the help.

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Panic Attacks?

by Kristina Randle, Ph.D., LCSW June 14th, 2023
written by Kristina Randle, Ph.D., LCSW

Basically.. every so often I get what I think are panic attacks. For absolutely no reason what so ever, my hands will get this weird sensation like they’re just bones and then my thoughts start racing unbelievably fast. My breathing, my talking, my movements seem way too fast. The feeling is incredibly intense and terrifying.

After my thoughts start to race, I hear things like.. screaming and crying and in my head I know it’s me doing these things. It feels like I’m screaming at myself.. like hurting myself but I’m the victim at the same time. I get a lot of dejavu feelings, like flashbacks. My Mom said I used to describe these skeleton hands to her when I was younger and I only vaguely remember that.

The second or third attack was the worst.

In my head I saw what I can only describe as a witch in my brain.

She was screaming at me and she scared the crap out of me. The screaming seemed to intensify with thoughts of getting help.

I texted my friend and it automatically stopped.

It felt like my thoughts didn’t want to be known by my friend.

I kept thinking she would come back so I slept with the lights on.

My friend suggested that I try thinking about something good when these things happened so I tried to imagine my best friend Jasmine but it back fired on me. As soon as she popped up in my head, she started yelling at me.

These attacks are never triggered by anything and only last for a couple minutes but time doesn’t really matter when they happen.

I guess the only thing i can really think of with the whole “If anything of significance also recently happened in your life.” thing is that I was molested by my Dad two years ago and I was addicted to drugs at 14. I also self mutilate and am way too sexual for my own good.

I strongly recommend that you be evaluated by a medical doctor. You may be experiencing panic attacks but it’s important to rule out a medical cause. I would advise you to talk to your parents about seeing a primary care doctor or a neurologist.

You should also be evaluated by a mental health professional. A mental health professional may be helpful in determining if you’re having panic attacks. If they are panic attacks, please know that it is a very treatable condition. This condition usually requires therapy in which you learn an alternative way to cope with anxiety. Therapy focuses on giving you the psychological, emotional and behavioral tools you’ll need to combat panic and anxiety. Some people also take medication as a form of treatment. It has been found to be helpful in decreasing panic attacks.

It seems as though you have been dealing with very difficult issues. You’ve mentioned that you were molested by your father, were addicted to drugs by age 14, engage in self-mutilation and are sexually active. All these aforementioned issues could be related to why you are experiencing panic attacks, if that is in fact what is occurring. Talk to your parents about being evaluated by a medical doctor as well as seeing a mental health professional. It’s important that you make contact with medical and mental health treatment professionals as soon as possible. If you’re not sure how to speak to your parents about these issues then bring them this letter. It explains your concerns. Good luck.

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Overbearing Undiagnosed Depression

by Kristina Randle, Ph.D., LCSW May 3rd, 2023
written by Kristina Randle, Ph.D., LCSW

I’m twenty-one years of age. I suffer from tremendous depression, although I am undiagnosed. It’s reaching an unbearable pinnacle, and I feel that if I don’t receive the appropriate assistance, that things will progressively accelerate and I’ll never be an effective person. The depression arises sporadically but frequently, and I can honestly say I’ve spent more time depressed than happy throughout the course of my life. As a result of my depression, my sleeping pattern is highly unstable, unpredictable, and unhealthy. I’ve noticed it seems to vary depending on the season, or perhaps my observation is purely psychosomatic. It seems that during the spring and summer seasons, I’ll manage to crawl into bed around five or six a.m. During the colder seasons, I might not get to sleep until noon, thus I’ll wake up around eight p.m., and I’ll end up napping from around midnight until three a.m. My bedroom is an absolute atrocity. The nature of it is so terribly embarrassing, and I’m beginning to feel ashamed of myself. Several months ago my father passed away due to multiple sclerosis, and shortly thereafter I developed a fear of death, and also began having panic attacks.

I honestly feel as though I’m falling apart. I feel as though I’m past the point of recovery. I feel like crying. When I truly think about it, I’ve got so many unresolved issues churning inside of me. What’s worse is that I’m alone. My family can’t seem to comprehend where I’m ever coming from, and on top of that, I’ve never felt comfortable speaking with them about personal matters.

Here’s the exact nature of my question: First off, I have hardly any money, nor health insurance. How can I go about receiving psychiatric attention? Secondly, I know that I need antidepressants, but I’m also frightened at the potentiality of misdiagnoses. I’m afraid that an inappropriate dose, or the wrong medication altogether could only worsen me. What can I do to alleviate these concerns?

Thanks in advance, Brian

Dear Brian, please know that you are not “past the point of recovery.” You are simply at the point where you recognize that outside help is needed. Being able to recognize when outside assistance is required is a sign of an insightful person. Moreover, because you are open and willing to seek help, now is probably the time when therapy will be the most beneficial to you. I am glad that you’re ready to receive help.

You asked about where you can seek treatment without much money and no insurance. Do you attend college? Most colleges have outstanding counseling centers. Their psychological services are usually very comprehensive and free of charge to students.

If that is not an option for you, try your local community mental health center (CMHC). Most CMHCs employ therapists, psychiatrists and case managers. Check the phone book (usually in the front section of the White Pages and listed under “counseling” or you can check under “psychological services” in the Yellow pages) for these services. Usually, CMHCs offer free or low-cost counseling services. You might even be eligible for a mental health program that would pay for your counseling. Each CMHC is different and you would have to check with your local agency to see what each offers.

You can also try doing an Internet search for “cheap or free counseling services” in your area. Many communities have their own small, individual programs that assist individuals who need counseling who have limited funds and no insurance. You might have to search for a program that meets your needs but it will certainly be worth your effort.

You mentioned that you know that you will need antidepressants. Antidepressants are not always indicated in the treatment of depression. Many people are able to decrease their depression through talk therapy alone. Antidepressants are helpful to many and you may benefit from them but don’t assume they are always required.

You said that your father recently passed away. Losing a parent is extremely difficult and it is likely that part of your depression is related to this event. Because of your recent loss, you might want to also consider a grief support group. It might be helpful to interact with other people dealing with the loss of a loved one. If you are interested, you might want to check out this link to grief support groups.

I hope some of these suggestions help you find a way to access treatment and please remember that it is never too late to seek help. Thanks for writing and I wish you luck.

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I feel as if I have failed

by Dr. Marie Hartwell-Walker May 1st, 2023
written by Dr. Marie Hartwell-Walker

Q: I feel I’ve failed and I just don’t know what to do… I have a friend who’s been diagnosed with depression. She’s taken therapy, has been given medication, has attempted suicide, and cuts herself. For a while, more like a two years, I tried as best as I could to stop her from doing those things. Yet, most of last year she missed school because she was sent to this place. I thought she was getting better… It seemed like she was. You could honestly see a change. About a month ago she emailed me, well, we had been emailing all over the summer, and then she asked me a question. Well, I answered. Then a couple e-mails after that she sent me one saying, “Kathryn, please don’t be mad at me if I don’t e-mail you again.”

Honestly, my thoughts were she’s going to kill herself, or something along the line. Well, I moved this summer, so I couldn’t actually be THERE to help her. I did go to school with her, but not anymore since I moved out of state. I got words from my friends that they found suicidal plans, and that she was sent away again to the same place.

I just don’t know what to do. I feel like the life drains out of me then comes back to life. Like last night I was watching my favorite music video, one that makes me cry. And then I just went into this breakdown. I went into the bathroom, shut and locked the door. Then just started crying. I was probably in there for about half an hour just sobbing. And it hurt a lot. Well, I cleared up my face. And about another half hour later I got a call from one of my other friend’s, and all the sudden I was happy, laughing. And I was laughing with my mom as well.

I don’t know. My moods have just been hectic, all over the place. Right now I feel really depressed, like there’s something squeezing and building in my stomach. I just don’t know what to do anymore.

You are NOT a failure for not being able to do what a hospital and all its professionals apparently haven’t been able to do either. You are one amazing 14 year old! You’ve been trying to hold your friend together for 2 years! That’s much too big a burden for anyone (teen or adult) to handle. It makes absolute sense to me that you are starting to collapse under the pressure. Your friend is in very serious psychiatric trouble. You are probably also feeling sad for her and very, very mad at her for putting you and all your friends through this. It’s a wonder that you didn’t get upset long before this.

What you need to do now is tell your mom or some other trusted adult about what you’ve been trying to do and how you’re feeling. I think it would be very helpful for you to find a therapist — not because I think there is something wrong with you, but because I think you need some help and support for sorting out how to pull back from this situation without feeling enormously guilty. You’ve done everything and more that a friend can do. It’s time to turn her life back over to her and focus on your own life.

I wish you well.
Dr. Marie

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I Never Feel Good Enough

by Dr. Marie Hartwell-Walker April 14th, 2023
written by Dr. Marie Hartwell-Walker

Hello, first of all I’m going to thank you for taking time to read my story. I’m 14. I wil start off by saying that my parents are divorced. I go one week with my m an other week with my dad. When I was little my parents used to fight, Horible fights, when I close my eyes I can hear them telling at each other, other than yelling at them selves my mom used to yell at me, to the point where she went pysco. Se kicked things,pulled my hair, throw things, said things to me that still hurt when I remember them. I grew like that all the time. When my patents fought I would be in my room crying my eyes out. Time went by and my dad got tired of being in that situation so he divorced my mom, he said it was the best I was 7 at the moment.

I agreed that it was the best things to do so I don’t have to hear them fight al the time. My mom made this insane lie that she couldn’t feel part of her face because of all the stress , she blamed my dad for everything. My mom and me were renting an apartment with her cousin and it was fine, my dad had an apartment as well but by himself. My mom met this guy and they’re married now, I should be happy but I’m not.. I accepted him though. Sometimes she wanted me to go to his house to get to meet him but I didn’t want to do she went into a phyco mood and started yelling and yelling, I ddnt get why ? It was her life not mine.. When I get mad I tend to cry. I dont yell or anything I keep everything inside and cry as my way to express how I feel. I ended up going and it always was like that.

My mom always wants everything her way she doesn’t care of anyone who she stomps on to get why she wants. I was 11 at this point, my dad didn’t like the guy my mom married and he still doesnt. Me and my mom are in a fight right now she kicked me out of the house and told me horrible things and that I’m not a good daughter. I think she’s not the best mom either,

I always try to be the daughter she wants.. Im never good enough. I close my eyes and I can remember all I went through. Her words buzz around my head, I think I’m marked forever.. I’m scared of her. My dad is the only person there for me he listens to me and he’s the best person in the world. One day my mom was angrily brushing my hair pulling my hair back into a pony tail and she hit me with the brush I turned around and she tried to hit me again but I grabbed her arm and pushed her back, my mind went black, I couldn’t take it anymore I felt like I wasnt thinking I just reacted, I don’t even want to remember what happens after that, I keep so much inside I don’t tell anyone, I can’t trust anyone.

In school I’m smart I have good grades and I’m trying to get into a good college but I have self confidence issues and really low self esteem. IM NOT GOOD ENOUGH. Everything is wrong with me. My mom told me I was fat. I believed it everyday I looked at te mirror and hated my self my mind was devestated. I’m putting this out here at 1:40am because as I’m laying in my bed those moment go thought my head and they hurt me, in so many ways. Please help me.

Thank you so much for writing. Your letter is an important step in your own healing. It shows me that you know in your heart that you didn’t deserve the treatment you had from your mom when you were little and you don’t deserve it now. Now we need to help you get your head in line with your heart.

You’re just like any other kid. You want your mother to love you. You long for her approval. You hope you will find some little thing that you can do to convince her to love you as a mother should.

I’m very sorry to have to tell you that it’s unlikely you will get what you are longing for. I can’t offer you an explanation for your mother’s behavior since I don’t have enough information. But from what you say, she has never been able to put other people’s needs ahead of her own, even her own child’s. She doesn’t give you love and comfort because she can’t. If a well is dry, it can’t give you water. At some point, it only makes sense to be sad about it but to go looking for another well.

In your case, you are lucky. There really are other “wells” of love available to you. Your dad is there for you. I’m guessing your teachers also think you’re smart and promising. At 14, you’ve grown up enough to know that you can survive without your mother’s care. You do need love but you don’t need hers. It’s time to do the grieving that comes with that realization and to reach out to others for the emotional and physical support a young girl needs and deserves.

Please ask yourself why you are choosing to believe your mom over your dad. You yourself call your mom “Psycho” but then you let her opinion take over the good opinions of your dad, your teachers, and even yourself. Open your mind and your heart to the people who really do think you are quite good enough as you are. They are right. Your mother isn’t.

It might be helpful for you to find a therapist to help you make the shift. Giving up on your mother won’t be easy after so many years of longing. To let yourself feel good about yourself is to give up on the argument you’ve been having with your mother. You really don’t need to convince her of a thing if you can embrace the reality that you are a good, smart, insightful, and attractive person. On some level, you already know that. But it just might be helpful to have a therapist help you connect with what you know is true.

As you enter your teens, it is a good time to do this work. A strong self-esteem will help you better manage the high school social scene and relationships. Appreciating your own talents and intelligence will let you do well in school. With a foundation of self-respect, you’ll be better able to have the future you deserve.

I wish you well.
Dr. Marie

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How Can I Reach Out to My Family?

by Kristina Randle, Ph.D., LCSW March 13th, 2023
written by Kristina Randle, Ph.D., LCSW

Q. Ok…this is going to be long…My parents got divorced 2 years ago. My father got custody of me and my now 20 year old brother. My brother and my Grandma (my mom’s mom) stayed in my old house while me and my dad moved to South Florida for a new start at life. He would often leave me at home, alone, and this was the first time I had ever felt so lonely. I was so lonely that I cried every night. In the present time, Me and my dad still live in South Florida. My brother went to college, and my grandma got an apartment. To this day I am still very lonely and cry every day (I’m home alone all day) and at night. My dad doesn’t know how sad I am and I don’t know how to tell him. We used to be close, but now we as far apart as ever. He leaves at night and comes home at 2 AM. I don’t know where he goes, and I figure it is none of my business. I am very lonely and very shy. I have no friends because I am so socially akward. I even have a hard time talking to my family. I feel so hopeless. I think I have depression, but I am not sure. I miss my dad. I miss having friends. I cry so often that I am starting to get wrinkles in my forehead and I am only 15. I don’t what to do. I feel like I have nobody. Please give me some advice. I am crying as I am writing this…I need help. What should I do?

It is understandable that you are sad. Your life has been disrupted by your parents’ divorce and your family has been split apart. When your parents divorced, you lost your home, your town, your school, your friends, your family and probably much more. Everything that you used to know is gone and you are now living practically alone in a new state, without most of your family or friends. Almost anyone would be struggling, given the type of life changes that you are encountering. What happened to you is not fair or easy. You unfortunately are a victim of their divorce.

You said that your father leaves you alone all day and night but you do not feel that it is “your business” to ask him where he goes. Please know that it is certainly “your business” and your right to ask him where he goes. It is also appropriate and advisable to ask him to spend more time at home with you. He moved you to a new town and therefore he, as a parent, is responsible for helping you to become familiar with your new surroundings. This is his responsibility as a parent. This is his job and he is currently not doing it.

It may be that your father is working to establish himself in your new town. This may be why he is rarely home. Part of the time he may also be socializing and that is why he does not come home until 2 a.m.

It is normal to feel sad and lonely in your situation and it is okay to ask your father for help. I strongly advise you to go to your father and tell him how you feel. Be honest and open with him. He may have no idea how you are feeling. Tell him that you do not like staying home alone and that you would like him to be with you more often. Tell him everything that you wrote in this letter. If you feel uncomfortable approaching him, why not give him the letter you wrote to me. Your letter does a nice job of explaining how you feel. You may even want give to him my response to your letter. Thanks for writing.

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No self-esteem following a betrayal

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP March 1st, 2023
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I am 21 years old, and lately I’ve been experienced a lot of anxiety. My childhood was a normal childhood, I am the oldest of four children, my parents are married, and both work and I grew up in a small town and had a really happy normal childhood. Since I was little (about 12) I lacked self confidence, but then I started gained it, and by the time I was 15 I was in a pretty good place in my life, I loved it, I had many friends a happy and great life, and that year I met my current boyfriend. After a year of being together, he cheated on me with another girl, that killed me he was the first person I had ever truly loved and he did that to me, he apologized and begged for me to take him back so I did; and we’ve been together since then. A year or so after that, he moved out of the country and we broke up, I was devastated, because I felt like after all the years spent with him nothing counted, and it was when this whole paranoia and lack of self confidence started. Not so long ago he asked me to get back together, I was really happy but then again my situation of low self-confidence and self-esteem got worse each day. Currently I feel like I have no control over my actions, I feel like in my past I was really outgoing and could make friends easily, now I can’t, I feel as if I am boring and I rethink a million times everything I want to say or do, which as a result brings having a difficult time meeting new people. I feel paranoid all the time thinking people are going to talk bad about me behind my back or will think I look bad or I’m fat or ugly, I feel as if I have lost all of my personality. I get really furious at myself almost everyday when I see pictures of other girls my same age or even younger than me that I know partying, traveling and having a great time, while I’m sitting at my house not enjoying my youth, because my paranoia of not being good enough won’t let me. These problems have affected my relationship with my boyfriend and my family. My boyfriend constantly tells me that I have changed, that I am not as fun and adventurous as I used to be, that I acted as if I had lost my personality, the one which he fell in love with, and I feel he is right, I also feel scared all the time that he will leave me any time and find a girl that is happier and more fun than me. Rewarding my family, I’m always moody I treat my brothers and sisters very bad, by getting easily irritated by them and I find myself screaming and yelling at them all the time, as if I had no patience with them and could not stand their site. Not only has my personal life has been going down the drain I have also been getting bad academic reports, in the past year I have failed 2 classes, and my grades have decreased incredibly. I mentioned the fact that my boyfriend cheated on me before, because I feel that in a way this has to do with everything that I am going through right now, after that happened my life started going down the drain and it hasn’t stopped. Every single aspect of my life was affected by the fact that the person I loved and trusted the most betrayed me, cheated on me, with a girl I even knew! I forgave him because he demonstrated he cared, and he showed me in so many ways he loves me and he was so extremely sorry. What makes me more mad it is not the fact that he cheated on me, but the fact that this girl with who cheated on me with had everything going for her, even though she is a horrible mean person she seems to have everything in a perfect way, perfect hair, perfect car, perfect body, perfect friends, perfect everything and I don’t. I feel like myself is in ruins, literally. Another thing that makes me so uncomfortable is my boyfriend’s family; because of my low self esteem and the fact that I am so different in every way from them, I feel as if they hate me; I’m paranoid about what they might think of me, when I’m with them I’m afraid to speak or say something, because of the fear of making a fool out of myself, so I come off as rude and shy, so I have no idea what to do. I feel so alone because I have no one to talk to, no one to express myself with, I have no friends, I have gotten FAT I have gained more than 10 pounds from eating so much (anxiety), my boyfriend lives in another country and currently reminds me of how much he’s noticed that I have changed, my academic has been awful, I am depressed, I cry every single night hoping my attitude will change. Please help me, I have tried to change but I feel lost, I feel as if something is missing, I am not satisfied with my life, I feel as if my best years are going by and I’m in my room crying and eating. Please help me I feel as if I have no control over my life, what do you think I should do?

I am glad you are taking care of yourself by reaching out to us here. Your self-esteem has taken a hit because you are too dependent on your boyfriend as a barometer for your own emotional wellbeing. This isn’t a very functional relationship, from what you are telling me, and I can understand why you would feel insecure and anxious. Your trust in him is shaky (at best). He is living in another country, and his criticism of your changes doesn’t help. It is time to reclaim yourself and become more self-reliant and resilient.

I am not suggesting you end the relationship, but I am asking you to put it in perspective. It sounds like you are drawn to his potential rather than his reality. Obviously you get something out of the relationship, but don’t confuse what you want him to be with who he is.

I would begin reclaiming your life and work on getting yourself back. Start a program of taking care of your body, your intellectual development and your emotional wellbeing. Your boyfriend cannot do these things for you. You have to take care of yourself. If you do this it is a win-win situation. If the relationship survives then you will be less needy and more capable and happier in it. If the relationship doesn’t survive you will be able to move on with confidence.

A therapist during this time is a good idea. If you don’t already have one you may want to begin and create some emotional support. The college you are going to will have a counselling center with a number of qualified therapists.

Wishing you patience and peace,
Dr. Dan

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Confused with Depression

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP February 24th, 2023
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I’m 16 and I’m not really sure what to do with myself. The past few months have been really hard; my “depression” has gotten really bad. (I put depression in quotes because I have not been diagnosed by any doctor. I’m assuming that this is what I’m going through after having done research online, and from my mom (who has depression) coming to this conclusion after I told her how I feel.) I have been really stressed with school and the craziness of my schedule lately, but it’s all stuff that I used to be able to deal with. It’s very often been difficult just to get through the day. I want nothing more than to hide from the world, and I cry all the time. I get extraordinarily sad and upset for no apparent reason, for hours or days at a time. I feel like I’m constantly on the edge of breaking down, and little things that shouldn’t bother me are liable to set me over the edge. I just can’t deal with anything it seems.

 

I used to be that girl who was always happy and always smiling, and even when this started, I was able to pretend I was, and became very good at hiding my true feelings. But now, many days I can’t even keep up this pretend face, and it’s all I can do to keep myself from breaking down right there in public. I feel like I’m just being weak or pathetic because I cannot think of any reason for me to have depression, but whatever it is is really wearing me down, and making me very unproductive and unsocial. Most of the small amount of energy I have now is spent keeping myself from curling up in a ball and crying at school, and I have a lot of trouble concentrating and keeping up my grades.

 

I’m very introverted, and have a lot of difficulty explaining and even admitting this to anyone. Almost none of my friends or family know I’m having issues. Even writing this is extremely hard, but I’m at the point where I seriously think I need help. I have self-harmed a few times, and thoughts of death are a norm in my everyday life. I don’t know what to do, or how to get help. Where do I start?

You did the right thing by talking to your mom and writing us here. There are many possibilities that may be causing your symptoms and I think the first thing is to have your mom make an appointment with your physician so you can have a physical. The physician can help sort through whether this is psychological or physical and make comments and recommendations from there.

You will also want to talk to your high school’s guidance counselor to see what he or she thinks. Talking to others who can help is the best way to start feeling better.

If you are experiencing thoughts of death and are unsure if you are depressed, it’s important to seek professional help as soon as possible. Here are four ways you can get help and find out if you have depression:

  1. Talk to your primary care physician: Your primary care physician can evaluate your physical health and refer you to a mental health professional who can help you determine if you have depression.
  2. Contact a mental health professional: Mental health professionals, such as psychologists, psychiatrists, and licensed clinical social workers, can help diagnose and treat depression. You can contact a mental health professional directly or get a referral from your primary care physician.
  3. Reach out to a crisis helpline: If you’re feeling overwhelmed or in crisis, you can reach out to a crisis helpline. They can provide you with support, resources, and information on how to get help. The National Suicide Prevention Lifeline is a crisis helpline that you can call at 1-800-273-TALK (1-800-273-8255).
  4. Take an online screening: Online screening tools can help you identify whether you may have depression or other mental health conditions. These tools are not a substitute for a professional diagnosis, but they can help you determine if you should seek further evaluation. The National Alliance on Mental Illness (NAMI) offers a free online screening tool on their website.

 

Wishing you patience and peace,
Dr. Dan

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