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Gp

Diagnosed With MDD But Am I Borderline?

by Kristina Randle, Ph.D., LCSW June 16th, 2024

I have treated for major depressive episodes but think i should have been found to have borderline personality disorder. Even as a child i always felt different from my family & friends and so when as a teenager i had to see a psychiatrist no-one was really surprised. i had my finger on the self-destruct button for most of my teenage years (and for many other periods in my life) my self-harm took on many forms. taking too many drugs, alcohol, picking up men for sex that i never enjoyed, making rash dangerous decisions then being scared of the dark or a tiny insect. my sister called me a freak of nature and it is true. I was sexually abused by a family friend and also bullied by an older brother who loved seeing me in pain (it was his friend who abused me)i got in trouble with the police on several occassions i have been on various medications over the years from anti-depressents, anti-psychotics and mood stabelisers and although for some of the time i felt ‘better’ i never felt normal and still dont. i have now stopped all medication and seeing the psychiatrist but see my G.P. who is a good man. I tried explaining to him that the medication and the ECT may have stopped me committing suicide they never stopped me self-harming or make me feel normal. he suggested i may have been born this way, and that it might be part of my personality. is this possible. would this explain me being as i am. I am currently married and this relationship started in my early 30s, this was my 1st real relationship, as i went between picking up men and kissing women. i get very angry for no reason and my moods are very intense and passionate often within the same day and all of this was when i was still taking the medication and was one of the reasons i stopped. after speaking to my GP i went online and i quickly discovered that my symtoms may well be a personality disorder that has been plagued by depression. is this possible. i eagerly await your reply.

If I understand your question correctly, you want to know whether you have borderline personality disorder vs. major depressive disorder (MDD). You seem to meet some of the criteria for borderline personality disorder and depression. It’s also possible that you have bipolar disorder (vs. your current diagnosis of MDD, not in addition to). Some of your symptoms match that disorder as well. Please keep in mind that I can’t be certain of your diagnosis. I would need to meet with you in person and review your extended personal history, but based on the information provided, borderline personality disorder or bipolar disorder are plausible diagnoses. These are possibilities, not definitive diagnoses.

You also want to know if it’s possible to be born with certain problematic traits or personality characteristics. This is a matter of long historical debate. It is a question of nature vs. nurture. In essence, you want to know if you were born this way or if your environment shaped your personality and led to a mental illness. Science has not determined the answer to this question. Some believe mental illness is purely a brain disorder and the problem is caused by a chemical imbalance. Some believe that behaviors are learned or that our parents and the way we are raised shape our personality. Many theories exist but none have been definitively proved. Many scientists believe that mental illness is a result of a complex combination of biological or genetic risk factors and environmental stimuli.

I usually try to discourage people from focusing on gaining an exact diagnosis. There are two basic “schools of thought” on whether a mental health diagnosis is helpful. On one hand, if an individual suffers from a series of symptoms and then learns there’s a name for this specific set of experiences, it can be a relief. It can also be a validation. On the other hand, learning of a specific diagnosis is not always very informative. Nor is it easy to know whether the diagnosis received is accurate. Mental health diagnosis is not an exact science. In addition, getting a diagnosis may make an individual feel upset, overwhelmed, hopeless, and even stigmatized.

What’s most important is that you find a way to relieve your symptoms and live a happy and fulfilled life. Troublesome symptoms make it difficult to function. It can make life miserable and you unhappy. You may not need medication but at the very least, consider individual therapy. You mentioned that you have problems managing your mood. Therapy can help with this. You also said that you are struggling with relationship/marriage problems. Again, this is the type of issue for which therapy could be very helpful. Try asking your general practitioner (I’m assuming this is what you meant by GP) or your psychiatrist about referral to counseling. You may also want to try searching this therapist directory. Thank you for your question and I wish you the best of luck.

June 16, 2024 0 comment

No Help in Brazil

by Kristina Randle, Ph.D., LCSW March 21st, 2021

written by Kristina Randle, Ph.D., LCSW

I moved back to my native country (Brazil) after about 10 years living in the United States. Life had lots of ups and downs in the US, both due to being an immigrant and due to being married very young to an immature and mentally unstable man. About 1 year before we actually moved back we started talking about leaving the US due to the economic crisis and also because my husband’s mental health was deteriorating. We both thought the move was the right thing to do as we’d be closer to family and friends, he’d have free healthcare, and also because of better economic prospects in Brazil.

Unfortunately, since we arrived, about 18 months ago, my life has been pure hell. None of the prospects panned out, my higher ed degree is not recognized here as it was earned in the US, my husband cannot get a job, both of his parents died within 12 months of our arrival and now he’s in a heated battle with his half-brother for the inheritance. Needless to say, his mental health has become worse than ever, our financial situation is not good, and our quality of life has decreased immensely. We have moved from city to city over here and we’re now living with my parents in a tiny town in a rural area. I cannot adapt to my own country’s customs and traditions, I miss the life I had before, I get really angry for having come back, and I feel helpless and hopeless about the situation. It’d be really hard to go back to the US now that we are broke and would have no job or home to go back to.

Lots of people have been telling me I’m depressed and I need to see a psychiatrist. The town does not have one, though, so I went to a GP and complained about having sleep problems. He did not even ask me any follow up questions to diagnose depression or any other mental problem, but he right away whipped up a prescription for 20mg of Citalopram daily. I took the first pill yesterday morning and I felt extremely ill all day. I was advised to take the second pill today anyway, so I did, but I’m really nervous about it. I had tried taking Prozac about 6 months ago, which was also prescribed without any formal diagnosis by my former GP, but the side effects were so crippling that I stopped after 8 doses. Now Citalopram seems to be making me very sick as well. What if what I have is not clinical depression? Will the pills hurt? If what I have is an adjustment disorder, is this drug the best treatment option I have, considering the lack of resources in the town and my financial situation? I appreciate any help, Thank you!

In Brazil, at least where you are located in the country, you don’t have the same kind of access to psychiatric services that you would likely have in the United States. Unfortunately, your options are limited.

Keep in mind that when beginning a new medication, it’s not unusual to experience side effects. For many medications, those side effects will subside after the first few weeks.

It is difficult to know if the type of medication that the general practitioner (GP) prescribed is the correct one for you. Finding the right medication often involves trial and error. Unfortunately, for the patient, this often means taking medications that temporarily produce unpleasant side effects.

Considering the limited psychological resources available in Brazil, you have to work with who is available. I would encourage you to report your side effects to the GP. You could also ask the GP about what other mental health services are available in the country. Ask if he or she has specific names or contacts.

The World Health Organization reports that Brazil has Psychosocial Community Centers (CAPS). CAPS seem comparable to the community mental health centers that we have in the United States. Though the CAPS program reportedly targets severely mentally ill individuals, social service workers associated with those facilities may be able to assist you in locating less intensive outpatient services.

Finally, you may want to consider returning to the United States. I understand the difficulties associated with such a move but at this point it seems as though you have nothing to gain from remaining in Brazil. The move might be difficult but the job prospects may be better in the United States than in Brazil. As you mentioned, your degree is recognized in the United States but not in Brazil. It may be something to consider. Please take care.

Dr. Kristina Randle

March 21, 2021 0 comment

Need Help But Too Ashamed To Get It

by Kristina Randle, Ph.D., LCSW March 1st, 2021

written by Kristina Randle, Ph.D., LCSW

I need to break out of cyclic depressive problem but humiliated to seek help. I believe that I am suffering from severe depression (and the site’s test also implies this), but cannot bring myself to seek help. Any time I have sought help recently or at a similar episode in the past, I have been unable to achieve anything from those I have approached, and have ended up feeling worse in the long-term. In a breakdown recently I tried to explain my symptoms to my mother, but was so worried about upsetting her that I only managed half-truths. She reassured me that I am just very tired, not feeling well (have been suffering from fluey symptoms recently) and just feeling a bit emotional. This helped a little bit, but things were back the way they had been in the morning.

I have experienced these depressed feelings and symptoms almost like clockwork between every 1-2 years. When the depression gets really bad I start to feel as though I am on autopilot and completely detached from reality. Sometimes it gets so bad that my senses start becoming a bit warped and I feel a bit like I am in a living nightmare – I hear sounds and my vision makes things move or change sending me into a blinding panic where I know I am being irrationally afraid but my rational senses are not really reality anymore.

The depression is often triggered by something distressing like a small failure or break-up but not actually caused by it (It feels as though there is no reason why I am upset – when people ask if I am upset about something I have no answer). As I said, this is not the first time, but each time this depression has outwardly displayed itself before, I have been labeled as purely over-emotional, lazy and even weak by those around and leading me. It has made me unable to seek help as I feel humiliated and isolated. The only way I feel able to tackle the problem is by hiding it and removing myself from any social/work situation where it might become obvious to my peers. In the past this has marginally worked and I have almost managed to get back on track, although this time through I feel the problem is far worse than before and I have resorted to daily self-harm in an attempt to take my mind off things. I am beginning to lose contact with friends and my college work is rapidly deteriorating due to lack of motivation, making me feel even more worthless and hopeless.

This time last year, I had the same problem and realised that I had to seek help in order to pass my high school finals so approached my GP. He was very sympathetic but unable to help so put me into contact with some kind of pysch doctor. At our meeting (where a psych student was also present), I couldn’t relax properly or open up. The doctor asked me various routine questions in an attempt to suss out whether I was a danger to others, or myself, but when she realised I wasn’t, passed me off as only stressed out and gave me the impression that I had wasted her time. Despite my GP telling me to contact again in the event that I felt the same way, I feel too stupid and humiliated. I am starting to think that maybe there is nothing wrong with me and I am merely melodramatic, weak, attention seeking and emotional. But if that is the case then why have I had these cyclic symptoms since age 13 (and which my mother is implying started as young as 8 although much milder at that time).

My ex-boyfriend encouraged me to speak to my doctor after collapsing in the street on the way to the studio in tears and immobility, but I feel like my faith in the health system is near non-existent and can’t bring myself to be brushed off another time (I think it could be the thing this time round to push me over the edge).

Any opinion from you would be greatly welcomed – I just can’t bear feeling so confused and alone anymore. All my sincerest thanks for the time you give me.

You are not weak, melodramatic or attention-seeking. You seem to be a person who is legitimately suffering from depression. People who are depressed are not weak nor are they acting so they can gain attention. If you had a friend who was suffering from depression would you tell her “oh shut up you’re just weak…stop pretending…snap out of it?” I highly doubt you would. You’d probably try to help and encourage her to seek help. You would not put her down or call her names like you are doing to yourself. You’d likely be kind and supportive to a friend in need of help. You need to treat yourself in the same supportive manner that you would a good friend.

You say that you are too ashamed or humiliated to seek help again. You feel that if you sought help again and it didn’t work out it might be enough to put you “over the edge.” I understand your fear but I don’t think your past experiences should stop you from trying again. Let me explain why.

Let’s analyze your past attempts to access help. The first person you went to for help was your mother. The advice she gave you was ultimately not very useful according to your letter. The problem in this situation may have been that you didn’t tell her the whole truth about how you were feeling. She didn’t have a fair chance to help you because you withheld the truth from her. There is a chance that had you told her the truth she could have helped you. It’s also possible that had she known how you were really feeling she still wouldn’t have been able to help. The point here is that she did not have the opportunity to help you fully because you withheld facts from her.

You then went to your general practitioner (GP). He was kind and sensitive but could not offer you much help. He then referred you to a psychiatrist (I am assuming it was a psychiatrist since usually that is what people mean when they say “psych doctor”).

Your last attempt to seek help was with a psychiatrist. The psychiatrist gave you the impression that she didn’t care. She also had an intern in the office. Out of fear and humiliation you never returned for a second appointment. It was these experiences that led you to decide to stop trying to get help.

With regard to your mother we already discussed the idea that you didn’t give her a fair chance to help you since you withheld the truth from her. Your GP seemed to care about your well-being but didn’t have the proper training to offer you counseling so he referred you to someone who might. You then went to one psychiatry appointment that did not go well and you never returned for another.

I can understand your hesitation to seek help based on your past experiences but in reality you’ve barely accessed the mental health system. The truth is that your interaction with the mental health system amounts to one information-gathering evaluation with a psychiatrist. You’ve never actually met with a counselor. You have yet to meet with someone who actually could help you. I usually advise people to see or talk to at least 10 counselors when they initially begin to look for help. There are good counselors available but often it takes time, patience and effort to find one you like. It’s not that you need to give this process another chance; it’s that you need to give it an initial chance.

Searching for a counselor is where you need to start looking for help. Generally psychiatrists do not offer counseling. Most psychiatrists only see individuals strictly for medication. You might benefit from medication but many people start with counseling first and then add on medicine later if it’s needed.

Your ex-boyfriend is correct to suggest that you try again to access help. Maybe he too realizes that you’ve barely given it a chance. You are suffering and without help this problem may only intensify. I commend you on your past willingness to seek help but now is not the time to give up. Giving up now would be illogical because as we’ve discovered you’ve barely begun the process of accessing help.

Lastly, you said that you’re ashamed and humiliated to seek help. You shouldn’t be. There is nothing to be ashamed of. People who seek help when they have a problem are brave, admirable and wise, not stupid, dumb or weak. If you are hurting and suffering as much as it seems that you are then why not seek help from trained professionals? Why would you choose to continue to suffer? If you had a broken leg wouldn’t you see a doctor? If you needed help with your taxes wouldn’t you see an accountant? If you wanted to lose weight and get into shape for a marathon wouldn’t you consider a personal trainer? You’d probably have no problem seeing a doctor for a broken leg, an accountant for a tax issue or a personal trainer to train for a marathon. If you’d have no problem accessing help from those specialized professionals then why would you be ashamed to seek counseling for depression? There is truly no difference. They’re all smart choices.

Meeting with a competent, qualified therapist could change your life for the better but you’ll never find one if you don’t try. Don’t give up on attempting to access help when you’ve barely started. Thanks for writing.

March 1, 2021 0 comment

Depression or Something More?

by Kristina Randle, Ph.D., LCSW June 10th, 2019

written by Kristina Randle, Ph.D., LCSW

I have concerns as to whether I am just a depressive person or whether I have BPD- I appreciate a diagnosis cannot be made via the site but advice on which direction to continue would be appreciated.

I am 34 married with one child. I have been together with my husband for 13 years – he is the only male I have never forced to walk away.

I have some very strong instincts that I was sexually abused by a non family male- although I don’t know who exactly or remember what happened. Certain things will trigger these memories white bedroom furniture- pink flowery items (like Cath Kidston).

Prior to being married I was in and out of relationships and had many sexual partners-but would always pick fights and make them leave- I thought that if they could put up with that they may be able to put up with me longterm. I also used to drink heavily my only habit now is that of the internet as much as 6 hours a night often lacking in sleep to fulfil what I want to do on-line. This is am sure contributes to my almost daily panic attacks- noises are a huge trigger- in part due to the rows that happened between my parents as a child I believe. My childhood was not great my mother basically neglected us after my parents separated my older siblings bring me up- she then fell pregnant and I was often left alone looking after a baby when I myself was under the age of nine whilst she went out -my siblings had either left to find work outside of the area or were also out running wild.

For many years I have had what I describe as out of body experiences – like watching myself on film. I also have periodic episode of self harm- usually when things feel out of control in my life. I tend to cling to what I know and dislike change immensely- even small changes such as having to change my route to work can aggravate me- lurching me into either panic or irrational anger. I have had or been diagnosed with three bouts of depression one aged 21 one aged 24 and then PND after the birth of my son- although I was quite low throughout the pregnancy. Due to family issues I sort help from my GP last summer who then referred me to a mental health nurse and subsequently to a psychotherapist for a 20 hour course of CBT.

Here I was told I have low self esteem and whilst that may be true I felt that there was something more. I tried broaching the subject with my therapist but was told they don’t deal in diagnosis as CBT is about the here and now. My CBT is now finished and I am dealing alone with the un-discussed transference issues that I had towards my therapist. On looking back through my life he is not the first person that I have idolised in this way and set out to find all I can (His address and phone number although not acted on either of these pieces of info).

I have times when I wont leave the house except for work and this has affected my relationship with my son. I am seeking to change this and am working with a post natal support group that my therapist referred me on to. My therapist(s) seemed pleased with my progress but I still feel a fake and a fraud. Aside from my husband ( who doesn’t help with my low self esteem) I have very little support one or two close friends who I see periodically and although I have a large family they seem hell bent on destroying me and like to add more pressure to my life my mother is an alcoholic and my father was absent for most of my life. I did the quiz thing via Sanity Score and scored at 157.

Does this sound as though I may have BPD or something else and should I try and get a formal diagnosis and continue in therapy- this would be a struggle due to current healthcare provision in the UK as I would most likely have to pay. What would be the most appropriate therapy for someone such as myself.
Many thanks for reading this.

Borderline Personality Disorder (BPD) may be a realistic possibility. You do match some of the symptoms. Another complication is the possibility that you were sexually abused. Further supporting this possibility are specific “triggers” that propel you into a panic attack.

The out-of-body experiences you have described are also characteristic of an abusive history. They are a form of dissociation. Dissociation is usually associated with a history of trauma.

I am not familiar with the UK healthcare system but if receiving a formal diagnosis is necessary to continue therapy, then you should pursue that option. In addition, it would be advantageous to undergo an evaluation to determine if BPD is an accurate diagnosis.

Cognitive behavioral therapy seems to have helped but 20 sessions does not seem to be enough. You continue to experience very problematic symptoms. If you do have BPD, CBT is typically not the first line of treatment. Dialectical behavioral therapy (DBT) is. DBT is an evidence-based and proven treatment for BPD.

In the meantime, you should learn all you can about BPD and its treatment. I would suggest reading books written about BPD by both mental health professionals and individual sufferers. All perspectives would be helpful. One book that many have found particularly helpful is I Hate You Don’t Leave Me. BPD workbooks exist that help individuals to deal with specific symptoms. You may also want to consider joining an online BPD support group/forum. We have one here on Psych Central. Face-to-face support groups may also be beneficial.

Do everything you can to get the help that you need. I wish you the best of luck.

Dr. Kristina Randle

April 20, 2011 0 comment

Can Therapy Make Depression Worse?

by Diane Walcutt, Ph.D. November 11th, 2019

written by Diane Walcutt, Ph.D.

From childhood through high school, I was never a “happy” child but I got by. Looking back at my worst I was “difficult,” sometimes moody or irritable. But I guess everyone around me chalked it up to puberty/PMS because no one ever said I should get help. In college, I developed an eating disorder. It was a major source of tension to my family, whose response was anger. They yelled at me to “eat” that I was “too skinny” as if I was doing it JUST to make them mad. They never offered to take me to a therapist, and when I tried to talk about my feelings about my body and food my mom’s response was that she didn’t want to hear it and I was over reacting.

So, I took it upon myself to get counseling at school. My mom didn’t care about my emotions, but forced me to see her GP so she could weigh me and give me a physical. Upon seeing this GP, she took blood work which revealed that my liver was inflamed from taking Tylenol PM on a regular basis to sleep. When I tried every other herb and natural supplement and nothing else put me to sleep, the GP prescribed me Seroquel.

When I told my counselor this, she consulted the school’s Psychiatrist. He said the Seroquel was a terrible idea for me. After meeting with him, he said I should be on medication for anxiety, not an antipsychotic. I told him I really didn’t want long term medication, all I wanted was to sleep so I could finish the semester’s classes.

He prescribed me Ativan, which worked wonderfully at helping me sleep. But he said the Ativan was really a band aid on a bigger problem and felt I should be on Celexa. After some consideration, I agreed to try the Celexa. I have been on 20 mg of it for a little less than a month and have been continuing to see him and my regular counselor for therapy. (I have to lie to my parents about where I am going since they don’t believe I need any therapy. My dad does not even know about my meds, my mom knows and strongly disapproves, claiming “you’re not depressed you’re neurotic”).

Anyway, lately I feel even though I care less about my weight, I generally don’t care about life because I am extremely unhappy. I hate my living situation (at home financially dependent on parents), I think I am ugly, I have no self esteem, and I just feel like a basket case. I know therapy is supposed to increase self awareness, but I think all this self awareness may be making things worse. I don’t know what to do. Sometimes I want to just “break up” with my therapists but I fear that things could be EVEN WORSE if I do that. Are some people better off without therapy? Or should I keep trying?

Hello and thank you for your question:

Goodness, you’ve had an awful time getting the help you need. I’m sorry that you have struggled so. I’m not a psychiatrist, so I can’t prescribe (at least in my state), but what you need to know is that if the Tylenol PM was working for your sleep, it wasn’t the Tylenol itself that was working, it was the diphenhydramine (Benadryl). Benadryl has side effects like any other drug, but it was the Tylenol that irritated your liver, not the Benadryl. Many people use the generic Benadryl with great success for sleep. What you need to know about it is that occasionally, it stops working. It is not addictive and you cannot develop a tolerance for it, but if you take a break from it, it will again begin working. The reason I know this is because I taught psychopharmacology at the graduate level for many years and have learned a lot about medications.

That being said, I wouldn’t break up with a therapist unless you think that particular therapist isn’t helping. Understand that therapists are like blue jeans. There are tons of them, but not all are a good fit. You might consider finding one that fits better. Or, you might just stick it out with this one. Things often get worse before they get better, since in therapy you have to dig into stuff that isn’t fun.

The other thing is that it sounds like your family doesn’t have very good boundaries. What is “wrong” with you isn’t their business since you are legally an adult now. Never mind who is paying for your schooling, if you don’t want to be weighed, and you don’t want mom prying into your personal issues, tell her in a very nice way, “Mom, I have to figure these things out for myself. I know you mean well, but I need some time to sort things out. I can’t eat what you tell me to eat, and I won’t be weighed anymore.”

She may have a hard time hearing these things, but you are an adult and should be treated like one. Set some boundaries, stay in therapy (even if it is with a new therapist) and take good care of yourself. You deserve it. If you want to find a therapist outside of school, look at the our therapist directory for one in your area.

I hope this helps,

Dr. Diana Walcutt

June 29, 2009 0 comment

Mother’s Mania and Med Refusal. Help.

by Kristina Randle, Ph.D., LCSW June 16th, 2019

written by Kristina Randle, Ph.D., LCSW

Q. My Mum was diagnosed as bi polar in 1988. She had severe highs and lows involving suicide attempts and when high over spending and running away with strange men. For the past 11 years she was fine until a GP advised her to come off her medication. This she did and within days started to become manic, this coupled with the stress of looking after an elderly relative tipped her over into a psychotic state. After a month she was sectioned and then transferred to another hospital nearer her home where the section was lifted because she began to take her medication freely.

However, she is still high, and doctors have advised her they want her to consider lithium, Mum has to take thyroxine as well and has had this dose reduced recently. Mum has been on lithium in the past and absolutely refuses to take it again. In addition to this and most frustratingly she also denies that she is ill and will not listen to anyone when she is told she is in hospital for her manic depression and treatment of such. My question is, is there an alternative to lithium that she will be offered or will the doctors be forced to section her again if she refuses to take lithium? Also, in her most extreme state she has said some horrible things to people and embarrassingly exposed herself to many people, what will her memory be of this? In the past she has remembered some things and not others, I don’t know if this is a choice not to remember though?

Finally, I am being quite direct with her when I speak to her, telling her why she is in hospital and what she needs to do to get better, because of this she sometimes will not talk to me or says horrible things to me, completely out of character, I am a ‘baddie’. Am I right to be so direct with her, I do get frustrated with relatives who just nod their head when she tells them she is only there because of her blood pressure and is coming out next week?

I apologise for all the questions, but I find it difficult to get sufficient answers from the nurses and doctors treating my mum, they all say different things.

I am curious about why her doctor advised her to stop taking her medication after having 11 years of success and stability. It might have been that she was complaining about the medicine and her doctor told her to stop, maybe out of frustration. She may have also misunderstood the doctor’s instructions, or decided to stop the medication on her own. Whatever the case, it’s clear that stopping the medication has caused immediate problems.

As for your specific questions, I will answer them below, one at a time.

You asked if there is an alternative to lithium for the treatment of bipolar disorder. I am not sure what medications are available in the UK but in the United States there are several alternatives to lithium. Some doctors, for instance, use a combination of antidepressant drugs such as Effexor or Cymbalta with antipsychotic medications like Zxprexa or Risperdal to control bipolar symptoms. How a doctor decides what medication to use in the treatment of psychiatric disorders can depend on number of factors such as symptoms, the availability of alternative drugs, cost, what is safe and what the client is willing to try.

You asked if when your mother is psychotic and behaving inappropriately, will she remember her actions and also, can she control whether or not she remember these events. These are interesting questions. The lack of memory reported during these episodes is a common characteristic of psychosis. The inability to remember does not seem deliberate. People do not seem to have selective memories. Many people legitimately cannot remember being psychotic, and even deny it ever occurred.

There are at least two possible explanations for why an individual may not be able to remember having a psychotic break. One reason is that psychologically, the psychosis is so horrific that a person mentally blocks out the event. This would be an unconscious defense mechanism. In this situation, the activation of the defense mechanism is involuntary. People who have had psychotic breaks rarely speak about these events and the few that do say that it was a “living hell.”

The second possibility for why individuals cannot recall how or if they experienced psychosis is that something is happening neurologically during the episode that blocks the memory.

The reason for the lack of memory during these episodes is complicated but to state it simplistically, it’s probably either a psychological or a neurological reason that inhibits a person’s ability to recall these events. There may be other explanations as well.

Xavier Amador in his book about serious mental illness entitled “I’m not sick I don’t need help” writes about the issue of lack of insight (i.e. you mentioned your mother has trouble admitting she is ill). Also included in the book is an interesting study that was conducted at Stanford University related to insight, memory and psychosis.

In the Stanford study, the researchers videotaped individuals during a psychotic episode and had the participants watch the tapes after they had been treated and stabilized. Prior to watching the video, the participants did not believe they had a psychotic episode and denied that they had any illness. It was only after watching the videotape that the participants realized that they had in fact had a psychotic episode. Many were shocked to see how they acted while having a breakdown.

Researchers do not know definitively if and how memory is affected during a psychotic break but there is some evidence that many individuals who experience psychosis truly seem unable to recall these incidents.

Your last question has to do with whether or not you should be “direct” with your mother. It is difficult to deal with a person who is unable to think logically. It can be very frustrating. If by direct you meant firm, concrete but still compassionate, I think interacting with her in this “direct” way is the best way to deal with her.

I hope this answers your questions. If you needed clarification or wanted to ask a follow-up question, please write in again. Thanks for your questions and I wish you and your mother well.

May 26, 2008 0 comment