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Continuing Symptoms Despite Treatment

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

Thank you. A month ago (or so) Dr. Kristina Randle helped me answering my question. (Misperceiving reality without medication). After reading the answer I decided to contact my former psychiatrist (the one I used to trust) and started a treatment with her.

I was feeling so much better and wanted to write just to say thank you, was not fine yet, but better, lot better. So thanks 😀 really.

I understand you answered my question, and don’t want to continue bothering you, but I’m in a little despair. My delusions diminished a lot, I think my official diagnosis is Bipolar Disorder with Psychotic features (or something like that), my mood was fluctuating, but was ok.

The thing is that 3 days ago I started to think of myself dead, uh… not sure how to say it. Like I see me killing myself in my mind (hope makes sense), was not feeling depressed or sad, actually I was fine, just this idea, and it started to invade my thoughts and now I just think in it. I don’t want to really kill myself, despite everything, I love my life, my plans. It has been hard to achieve certain stability, and I like being functional, but there’s this image that don’t leave me alone.

Then I started to listen other people’s thoughts (again), but I usually heard the thoughts of one person at a time, and now are a lot of thoughts of lot of people, so I can’t distinguish everything and my head is aching all the time because of the constant noise.

I wrote to my doctor explaining, I try not to call unless is a real emergency I don’t like when I am demanding, anyway I wrote to her, and she told me I have to give time to the med to kick in.

I know I have to be patient, but I can’t concentrate, or work, and I have datelines, and now I am starting to feel desperation, and don’t know how to deal with this until the med works fine, what if the meds don’t work? What if I’m not fine again?

And I ask myself if I really can’t control this or why am I doing it? Why a person would be like imagining things? Listening or seeing things that really are not there or happening? Am I just a freak? Should people be afraid of me? Should I stay away from people, to avoid hurting them?

And I feel so guilty and afraid for thinking of “me killing myself,” I know I like my life now (generally speaking), and was hard to get to this point. And people say that if you say it is just because you want attention, that people who wants to do it just do it. I don’t want to do anything like that, and also don’t want to have this images in my head, but don’t want to like to “call for attention.” How do I know if I have to say it to someone or not? How do I know if is real, and I should be worried or not? I used to want to die, I even try once and barely survived, and I am grateful I did, ’cause some years after my life improved and I liked it, but I feel ashamed as well (of feeling, saying and trying to kill myself and be alive) because it makes me feel like it was fake, that I was fake. Does that make sense? Should I ask for help or just wait until the meds work?

I’m sorry, I wanted to be just a thank you note, and I understand there are other people, and you have answered a question of mine before, so it’s OK if u don’t answer this time.

Thanks a lot for your time and previous advice.

I’m so glad to hear that you contacted your psychiatrist and have begun treatment again. I very much appreciate you writing back and letting me know how you’re doing. Thank you.

Please never feel that you are bothering me. I am glad to help you.

Your symptoms are obviously distressing but they are not your fault. No one would willingly choose to experience what you are experiencing. Those thoughts and images are essentially your brain playing tricks on you. It’s unfair, unpleasant, and frightening, and I’m sorry that this is happening to you. It will stop. It does take time. Be patient but also carefully monitor the suicidal thoughts that are occurring. If you feel that you might attempt suicide, you should call 911 or go to the emergency room. Keep your doctor informed about every change in your thinking.

You were wise to inform your doctor about your ongoing symptoms. Don’t feel like you’re a bother to your doctor. You are not. If you are a bother to your doctor, then she should find a new occupation. No good therapist would ever be upset with your providing the very information that they need to do their very best work. She needs you to keep her informed or she simply cannot do her job. What I am trying to say is you are being a responsible client. Without your self-reporting, she would not know how you are doing. As she noted, it may take time for the medication to “kick in.” Alternatively, your ongoing symptoms may be a sign that a dosage adjustment is needed. It’s important that you continue to inform her about your symptoms. It helps her to know whether your medication needs adjustment.

You may also want to consider the addition of psychotherapy. A therapist could help you to stay grounded in reality. For instance, he or she could help you to distinguish between what is real and what is not, teach you strategies for dealing with distressing hallucinations, voices, paranoia, and suicidal thoughts. During any distressing time, it’s important to surround yourself with a great deal of support. The more support you have, the better you will feel.

Thanks again for writing to let me know how you’re doing. Please consider writing back to keep me posted on your progress. I wish you continued success. Please take care.

Dr. Kristina Randle

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How Do I Deal with My Toxic Mother?

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

From a young woman in Macedonia: Hello. I would like to ask you how to deal with my mother who is always negative. First of all I must say that she is a good person and would never hurt me. However she has always been a very negative person which affects me really bad. Since I was a child,she has always been crying about her small health, financial and any other issue she would have. I’ve always lived in fear that something bad will happen,that she will die,that we are destined to be an unhappy family and I’ve never been happy in my home.

The first words I hear every morning must be her bragging or crying about something, its a very bad start of the day to see your mother unhappy but this is an everyday thing for me. She continues this during the whole day and even if someone says something positive she always has something negative to find. She is always crying,screaming to us,bragging how everything is horrible.When I try to talk to her about this,and tell her that this affects me really bad in every field of my life, she starts making drama and bragging to my father that I want to control her and that I am bad to her. Even though I only say to her that I want her to be more positive just because it will make us all happier, she tells me that I am mean,bad and horrible person who doesn’t respect her.

I feel very depressed because of this, she has made me think that things can never be good,never improve,there must be something bad in everything,that I am bad just because I don’t want to see her unhappy and bragging everyday…

If I tell her that I can’t listen to this everyday she tells me to go and live on my own than.I am only 20 years old student who can’t live on my own.I strongly believe that everything is energy, and wonder how to have a good positive attitude and life when I have such a bad energy coming from the most important person in my life.I must say that this affects my mental health really bad, I don’t want to wake up in the morning because I don’t want to listen to her , I hate my home, I am depressed and I am becoming negative on my own. I am very jealous to every happy family.

It sounds to me like your mother is profoundly depressed. She is looking at the world through a filter of negativity and despair. There’s a saying that every cloud has a silver lining. But for your mother, if someone gives her a silver lining, she immediately puts a cloud around it. It is a sad way to live, especially since it is so advanced that she can’t even let the love of a caring family help her change it.

You didn’t mention whether your father shares your concern. I certainly hope so. As a daughter, there is very little you can do to change your mom’s attitude. But your father may be able to encourage her to get into treatment with a mental health professional.

It is not healthy for you to deal with this constantly. Since you can’t yet make a home of your own, you need to find ways to “leave” without physically leaving.  Leave for school early. Get involved with school activities or a part time job that keeps you out of the house as much as possible. Find other young people who are doing positive things through volunteer work or an activity you enjoy. Spending time with them will help balance out the negativity of your mother.

Don’t argue with your mother about her attitude. You can’t change her. She will only change if she decides to get the treatment she needs. All you can do is let her know that you love her — which is a lot.

I wish you well.
Dr. Marie

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Everything Is Falling Apart

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

From a teen in the Netherlands: My life is a mess. I’m 15 y/o. I used to be a very happy person. A lot of stuff happened. I got bullied, switched schools, no friends etc., but it did nothing to me. I was still happy.

A few years ago this all changed. I got bad moods often. What I thought was SAD quickly turned into something more like major depressive disorder…. But i kept strong. This year, i got friends, and i thought everything would fall back into place. I was very wrong.

Everything hit me at once. My best friend had a failed suicide attempt. My other good friend got hospitalized because her depression got out of hand. My dad is mentally abusive (he always has been, but it gets to me more now). I have never hated myself more than I do now. I used to be so in touch with God, but I’ve lost him… A few family members passed away, the others are now all fighting with each other. Family used to be my only speck of light, but now that has faded too.

All I think about is the relief death would give me. I have some sort of eating disorder, i still eat, yes, but i really don’t want to. Ive tried to make myself throw up multiple times. There has been a period where I’ve cut myself. I feel like no one will ever love me. I also have very bad (social) anxiety. I hate people. All I want to do is sleep.

Whenever I try to talk to my mom about all this, she brushes it off as some kind of joke. I have no friends to talk with, because it’ll only make their own problems worse and that’s the last thing i want. I feel hopeless and worthless.

I do think it’s important to know I do not feel like this always. I have ‘good days’, fortunately.

I hope you can help me.

Sometimes life really isn’t fair at all. You have had more than your share of disappointments, tragedies and challenges. The fact that you still have good days is a testament to your inner strength. But it is no wonder to me that you are getting discouraged.

I do have to wonder if part of the mood change a few years ago might be hormonal. That’s why the place to start is with your medical doctor. It’s possible that at least some of what is going on is medical. Thyroid problems, even a vitamin deficiency, can have an impact on mood. Just get it checked out, ok?

But even if you do have an untreated medical issue, you still have experienced a cascade of difficult events. For that reason, I think a therapist would be helpful at this point. A therapist will help you build on that inner core of strength you already have so you will have healthy ways to cope. Therapy will also help you deal with the losses and sort out what you can, and cannot, expect from your family. Many teens find it extremely helpful to have a therapist who can hear their story without judgment and who can offer encouragement and practical advice.

I don’t think you want to die. I do think you want the pain to go away. As you have already discovered, cutting and developing an eating disorder doesn’t do it. Please believe me: Therapy does help.

If there is a counselor at school, you might talk to him or her about how to approach your mom with the idea of getting some therapy. If there is no counselor, maybe you can take a teacher or another adult into your confidence and ask for help.

When you go to a counselor, take your letter and this response with you. It will help your therapist get a quick overview of your issues.

I wish you well.
Dr. Marie

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Considering Suicide

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

I feel like I am close to possibly killing myself, and I don’t know what to do. I have these disturbing thoughts that had followed me into each night, and now they persist into my waking hours(they are thoughts of my throwing myself down a long flight of stairs, or throwing myself off of a tall building), there are thoughts of hopelessness and despair each and every day.

I am in love with a woman who only thinks of me as a friend, it seems that every woman now only thinks of me ‘as a friend’, I am unemployed with no prospects(but plenty of skills), I have few friends(but plenty of acquaintances), I live in my parents basement(which further destroys my self-esteem). I have not had a genuine sexual encounter with a woman in years.

I am disabled, though no longer seriously. Yet when I was more seriously disabled I had a lot of friends(women didn’t only think of me as a friend), I was working, and I had a descent sex life. I am now growing more and more cynical and untrusting of people(especially single women). I don’t want to be a cynical person, I want to trust people…..but if conditions persist, I fear that my self-loathing will grow.

It seems as if there is little hope for me now, if now that I am more physically capable women treat me as if I am not worthy of being loved, if now that I a more mobile I am not treated as if I am capable of working.

I am currently seeing a therapist, but I am worried that if I tell her about these dire thoughts she may be forced to have me locked up.

I fear for my life.

You are experiencing a difficult time. Virtually everyone can relate to having a similar period in their life. Problems are a part of life. They are inevitable. It is the nature of life. Bad times hit everyone, some not as bad as those you are going through and some much worse.

Life might be difficult now but it would be a mistake to believe that it will always be that way. Your life can improve.

When someone says they are considering suicide, I often refer them back to the stories of individuals who have attempted suicide but who had survived. Survivors of suicide attempts are a unique group. Their stories are both sad and inspirational. They experienced the depths of depression, decided that their lives were not worth living, attempted to end their lives but then recovered from that experience with a powerful and hopeful message: life is worth living.

Conventional wisdom might suggest that these individuals, who failed at their suicide attempt, would simply try again but they did not. Why? Because they realized that their lives can improve and even a troubled life is worth living.

Survivors were thankful that they had failed to kill themselves. Some felt so strongly about their experience that they then dedicated their lives to suicide prevention. They did not want others to make the same mistake that they had.

I would strongly urge you to speak to your therapist about your suicidal thoughts. Generally speaking, an individual cannot be hospitalized against their will unless they are posing an imminent threat to themselves or to others. The operative word is imminent. In addition, an individual has to have a specific plan for suicide or homicide, and the means to carry out their plan for them to be involuntarily hospitalized.

You are in therapy. You need to honest with your therapist so that they can do the job that they were trained for: to help you. They are there for exactly that reason, to help you in every possible way. You have chosen them so that they could help you, now trust them to do their job. Tell your therapist exactly what you are thinking, hold nothing back.

If you feel that you cannot keep yourself safe, then go to the hospital immediately. Call 911 if necessary.

You have access to a therapist. Utilize that help to develop better problem solving skills. Learning those skills will not make you immune to life problems but they can significantly improve your ability to solve those problems. Please take care and be fully open with your therapist.

Dr. Kristina Randle

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This Guy Is Leading Me On & It’s Killing Me Literally

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

I’m at a loss for what to do as its ruining my life. For about 2 years now I have been totally head over heels over one of my brothers friends. Nearly every one I know tells me that we make a good couple, even his own mother! I have been trying so hard to impress and make him notice me and I push myself to great extents to make him happy and I have based life decisions on what I thought he would think of me. Unfortunately, he has just treated me like I don’t exist. He has never even trated me like a friend or an equal. He ignores me and acts like im nothing in his eyes. But then again he also acts like there is a great chance of us being together and he makes out that he likes me back and I get really confused. I have BPD so I think that’s contributing to my heart ache. My legs are covered in scars thanks to him, yet I always want to be around him. Sometimes I feel such hatred for him that I could quite happily wring his neck but the next minute I’m drowning in despair over why he won’t love me like I do him. I put so much effort in for no return and it’s killing me. I don’t know why I can’t just forget about him. My thoughts are always riddled with what is wrong with me? I question self worth and I loath my self because I’m not good enough. I don’t know what to do anymore, this whole thing is ruining me.

Being “head over heels” in love can blind you to the many possible negative attributes of your love interest. In your case, you would like to develop a relationship with a particular person but he may not be interested. I’m also concerned about the intensity of your feelings for this individual. As you stated, “it is killing you, literally.”

It seems as though your life has revolved around this individual despite believing that he is not interested in a relationship. Your blinded devotion has led you to essentially mold your life around his, which has caused you significant physical and psychological pain. From a psychological perspective, this is not healthy.

I would strongly recommend counseling. It is important that you focus on developing a healthy sense of self-esteem. A lack of self-esteem is in all likelihood contributing to your unhealthy attachment to this individual.

You also mentioned that you have BPD which may mean that you have bipolar disorder or borderline personality disorder. In either case your symptoms, if not well controlled, may be contributing to this problem.

I’m also recommending counseling for two other reasons: this problem is significantly interfering with your happiness and you are engaging in self-harm. Self-harm is a sign that someone lacks the ability to solve problems in a psychologically healthy way. I hope that you’re able get the help that you deserve. Please take care.

Dr. Kristina Randle

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I Can’t Fake It Anymore

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

From Brazil: i used to be a creative, quite outspoken girl in school. then on the internet. on the internet, i met a boy whom i dated. we broke up in horrible terms, and it scarred me to today. that, plus a lot of other horrible happenings in relationships (friendships mainly), has led me to a state of constant alert, where i can’t enjoy my friends company because i’m constantly thinking on how to make >them< enjoy mine.

i’m avoiding my friends as much as i can in the last 3 months – even my friend which i know for 10 years – on social media, and i just feel useless and boring 100% of the time, so i prefer if i don’t even socialize at all. today i chatted with a girl that considers me her best friend and i can just feel she didn’t enjoy our time that much. my classroom, everyone talks it up and has friends and i’m the only one who doesn’t smile, speak a word or even look up. i’m just listening, looking at the floor with this blank ass look on my face. i feel like it’s just getting worse, worse, worse.

i used to be able to fake it, smile it out, joke it out, but i CAN’T anymore and i’m afraid of telling my mom i need a professional since my friend thought i was killing myself and told my mum on facebook. i told her my friend understood completely wrong what i told her, and she did, but that won’t be off her mind easily if i tell her to get me a psychologist.

i just… feel so tired all the time. i feel like i have to be this cute, sweet girl all the time. i’m f-ing not. i’m so… idk. i feel like everyone thinks i’m fake, and that’s something no one ever thought of me before, because i faked it good, for 3 whole years (: i feel like i have to be the popular girl once again to be happy, and my mind literally won’t let me. help. please.

Your horrible experiences with your ex and your friends severely shattered your ability to trust. I think that may be at the root of your isolation, loneliness and despair. I don’t think the answer is to fake it. You do need some help and support to regain your ability to trust other people — and to know who is worthy of your trust.

If you could solve this problem on your own, you would have done it already. I understand that you are trying to protect your mom from worry. But you are protecting her at the price of getting help for yourself. You may also be setting her up for far more pain.

Believe me: As a mother myself, I know that I’d rather deal with worry about my child than have to manage the guilt and regrets and grief if that child hurt herself. Take your letter and my response to her and ask her. I’m pretty sure I”m right about this.

Please follow your good instincts and find a local therapist who can help you.

I wish you well.
Dr. Marie

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I Feel Like My Life, and My Mind Are Out of Control. Is There Hope?

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

I grew up in an extremely abusive home. My mother used to watch me get beat, she too was beaten, and there was never anyone that could help me. At age 9, I snapped and decided to kill my stepfather, but on that day my mother’s parents came took me to live with them. They showed me love, and cared for me, but I have always felt like something was missing from my life. I have sought to fill that void through relationships, but all have failed except the one I am currently in. I have had a spouse that got hooked on drugs commit suicide, then got remarried years later only to be cheated on, and now I can’t stop being suspicious of my current spouse.

I relive my abuse everyday, relive walking in to a bathroom after coming home from work and finding my first spouse dead, relive my second spouses actions and betrayal. Most days I am a nervous wreck inside. I have tried to commit suicide a few times, but was unsuccessful. I am not currently suicidal, but I feel that any day that could change. I see a therapist, but they don’t live my life for me and can not be there when I need them to tell me what to do. I feel everyone is out to get me, to a point now where it affects my ability to work, have friends, and may eventually destroy my relationship I currently have. I am scared for my spouse to do things on their own cause I always feel they’re up to no good. I feel like my life is always on the brink of disaster. I am paranoid about everything, and everyone.

I want peace in my thoughts, but I react negatively to everything because I feel like it is a personal stab at me or my feelings. I feel like no one really cares about my feelings, feel alone even when I am with my spouse, and always feel scared. My stress levels are so high that most days I feel like I’m going to burst, like all my atoms are just going to fly apart at one time. My chest hurts a lot, my mind and judgments are cloudy or confused, and I feel like I may just kill over from a heart attack at any moment.

Is there hope for me?

Yes, of course there is hope for you. People are amazingly resilient. Recovery should be expected. Be patient and don’t give up. Your situation can improve.

One of my favorite books is Man’s Search For Meaning by Viktor Frankl. It’s a good book for a variety of reasons but most importantly because it demonstrates the power of resiliency and how to find meaning in the worst of all circumstances. Frankl was a prisoner during the Holocaust and was almost killed. Despite living through one of the worst tragedies in human history, he came out an optimist.

He counseled many people in the concentration camps. Some of his fellow prisoners were abysmally depressed and suicidal because of the near hell in which they lived but Frankl gave them hope, despite their circumstances. I believe his book will change the way you view your life and circumstances. Anecdotally, it has helped many people with depression. It provides concrete ideas and tools for overcoming suffering. It is a one-of-a-kind book, and I would highly recommend it.

You stated that you are in counseling. You have had traumatic events occur in your life and are still reliving some of those traumas. You might benefit from consulting a therapist who specializes in trauma. It might serve as a good adjunct to your current treatment.

In addition, you might also benefit from medication. It might help you to feel less “on edge.” It is exhausting to feel as though you are going to “burst.” It is important to relax. Exercise, meditation and so forth, could all be helpful. There are many ways to decrease your stress levels. Ask your therapist to assist you.

With full sincerity, I most certainly believe there is hope for you. As an experienced professional, I have seen many people overcome psychological problems and live joyful lives. It’s often a matter of finding the right treatment. Good luck and please take care.

Dr. Kristina Randle

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What Might Be Causing New Onset Of Delusions?

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

The past few months I have started to have mild delusions. The first that I can recall is the most frightening experience I can recall. I raced from one paranoid thought to another, lost control of my movement frozen in place but jerking my head around rapidly and hearing myself making a sound between a scream and a groan, and this felt like it would never end.

That was the most extreme though. Since then I have had one case that I was certain a shirt and empty plastic bag was a brick of marijuana that someone had made me hold on to and panicked that I would be found out by family or authorities. I can’t be sure if some other episodes have been a delusion or real. I have also had other occasions where it feels like part of my body is slipping and I can’t control it.

I have also been experiencing a new level of paranoia. Sometimes this lasts for a few minutes and sometimes for a few hours. I will be in complete despair or fright about family or an attacker. (possibly made worse when a man followed me noticeably in his truck as I walked unprotected for 20-30 min before I got help recently)

For some background…I was suicidal as a young teenager, but haven’t been in years.
A few years ago I displayed some disordered eating, but do not believe this lasted long enough to signify an eating disorder.

I have recently wondered if I am bipolar also because I seem to experience a roller coaster of despair and not wanting to talk to anyone or thinking I have no one to turn to, to suddenly feeling fine or even a rush of euphoria that I believe interfered with my school work.

Sometimes I feel like I just need to get drunk, but I rarely drink. I also may be struggling to cope without the aid of a drug, but I don’t believe I was truly addicted so I am unsure about this.

I had a brain tumor removed at age 6 somewhere around my spatial center, but have not had problems since, however it has recently been suggested that I may have some lingering side effects that have to do with my sense of direction.

I don’t even know where to start, what direction to look in, or how to communicate to a doctor.

The best place to begin is to make an appointment with your primary care physician (PCP). It is important to rule out a medical explanation, especially because you have a history of a brain tumor. As you mentioned, some of your symptoms may be attributable to the lingering effects of the brain tumor.

When you visit the PCP, provide a detailed report of your medical and psychiatric history. Also report your current set of symptoms. The more detailed you are about that information, the easier it will be for the doctor to assist you. You were very detailed in your letter. It might help to bring the letter to the appointment. Prior to the appointment, prepare a list of your symptoms and the questions that you have. Having a list ensures that you won’t forget important details.

Your PCP may suggest that you undergo a variety of medical tests. He or she may also refer you to a psychiatrist, a neurologist and a psychotherapist for additional tests or evaluations.

You alluded to the fact that you are either currently using drugs or you have a history of using drugs. I am not sure if you were referring to prescription drugs or to illegal drugs. Illicit drug use can exacerbate and in some cases lead to the development of psychiatric symptoms. It is important that your doctor is aware of all past or present drug use. You may not want to reveal that type of information to your doctor but missing facts can result in an inaccurate diagnosis and subsequently, an inappropriate plan for treatment.

It is important that you are evaluated as soon as possible. Start with your PCP. I hope this answer helps you to know how to proceed. Please take care.

Dr. Kristina Randle

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