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Schizotypal and Want to Stop My Medications

by Kristina Randle, Ph.D., LCSW July 18th, 2024
written by Kristina Randle, Ph.D., LCSW

I was told by a psychologist that I had a paranoid personality disorder and was scizotypal. I have always struggled to be part of society and been depressed since I was a child, together with many other issues such as body dismorphia, eating disorders, social axiety disorder etc etc etc.

I told the doctors that the only medication that had done anything for me was paroxetine / seroxat and they reluctantly put me on 40mg a day about 18 months ago. Since that I have gone from being someone who stared at walls all day alone to someone who has started a business and has some sort of limited life. problem is: I desperately want to come off these tablets as I feel sort of ok now but my girlfriend says if I do then I will go down again as its a pattern she has noticed.

Thing is, I dont know whether to trust her, I am sure she is using me simply to get into my business. Also I have noticed that she has put weight on and the same thing happened with my last girlfriend. Why do women put weight on and stop wanting sex when they date me, what is it about me that makes this happen?

I dont know if I have any mental illness or not, I am convinced that most of them are made up and that it is simply an industry to justify a proffession and nice salaries!!!

I know I should come off paroxetine slowly but I dont understand whether paroxetine makes me something I am not or makes me the person I really am.

Without the meds I cant seem to have a life but with them i feel like a fake like its the meds that are my personality and not me.

Is schizotypal something real or just something made up by psychiatrists to justify their proffession? Please tell me what I should do…………can I now come come off these horrible tablets albeit slowly and will I be ok if I do or will I go back to being a freak again?

Thank you for listening, (if anyone is that is).

Schizotypal is a real illness. The most comprehensive book available about schizotypal personality disorder was written by Adrian Raine. Reading about or studying the illness might lead to a better understanding of it.

I would discuss this matter with your prescribing doctor. Perhaps you and your doctor could create a plan for coming off the medication, slowly and over time. Part of the agreement could include a directive for resuming the medication, in the event that your symptoms return. It may be helpful to include your girlfriend in your medication plans. She would be an additional observer who might see or notice something that you might find important.

With regard to the problems with your girlfriend, you might be right about her using you but it is important to determine if you are right. A symptom of schizotypal personality disorder is suspiciousness. What evidence do you have to support your assertion? If there is no evidence, then your beliefs are very likely unjustified.

You complained about your girlfriend’s weight gain and wondered what it is about you that made that happen. Don’t assume that you are the cause. Complaints about weight gain are relatively common among couples who have been together for a while. One or both partners may “let themselves go” after becoming comfortable with their mate. She should be made aware of your unhappiness. Couples counseling could assist you and her in addressing this issue.

I want to commend you on your life successes. I wish you continued luck. Please take care.

Dr. Kristina Randle

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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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Distinguishing Between Bad Times and Depression

by Kristina Randle, Ph.D., LCSW May 5th, 2024
written by Kristina Randle, Ph.D., LCSW

I have tried a little of over 12+ types of antidepressants, augmentations (like adding an anti psychotic), and now I am on Lamictal + Pristiq; turns out I had treatment-resistant depression. I’ve had the last four months “good,” compared to previous times, where my depression was out of control (this lasted for ~ 4 years or so, and because of personal & family problems, the last 2 were the hardest times, which included suicidal thoughts and a couple of overdoses – I still have those once in a blue moon). I also went to therapy, which helped me much, as I got a lot of support from my counselor -my family is still reluctant, but I know I need to treat my depression even if they don’t accept it. In the past, my treatment with medicine was just simply not working; to the point that my psychiatrist suggested Vagus Nerve Stimulation, but I wasn’t all for it, so I’m on this new combination.

My PCP tells me I look different, that I smile more, seem happier, and that sort of thing. The last time I saw my psychiatrist, I did tell him I felt an improvement, which he also saw on the last two appointments and made comments of it as well. He also warned me that some days were not going to be like that, and that it was okay. I’ve been keeping track of my moods about every week, and some days I feel really good, others okay, and some, not good at all – make me feel like I should take the whole day off. To the point where, once again, I feel that knot on my throat because I want to cry, and sometimes, just sometimes, I do. I’ve called my psychiatrist’s office twice this month to tell him I’m not doing so good lately, as this happens about twice per week or so. I’ve not gotten a call back about it, but what really bugs me is that how do I know that depression is not going to take over me once again? How can I tell that my meds are not working well? Or how often is it “okay” to feel that way?

Having had major depression for four years, well, I really had forgotten what it was to feel happy, and I still remember that when I first started to feel good, I was in this great-awesome-wonderful-happy-excited mood and attitude just 3.5 months ago that I hadn’t felt in such a long long time. My counselor and I decided, about two months ago, that it was okay to stop going to therapy, she had suggested prior to the last time, but I just wanted to make sure I was ready. She still told me that any time I needed help with my depression to call her again.

I know about a month ago, I felt really overwhelmed with all the extra-work I was picking up, like giving extra classes during the week and on the weekends, working on a paper I want to publish, and working on some presentations for summer (all four things different in topics and audiences). I thought it was a good idea, as it would keep me occupied and because my mental state is so clear, that now I can retain and process material that before I wasn’t able to (unlike the last four years that caused me to drop out of a PhD opportunity and go back to my hometown and teach at a high school, not that is wrong to do that, but it was such a great opportunity that it still feels bad to have stopped).

Amazingly, and not sure if I’m right to do this, I want to take a part-time job teaching at a college, but now, I’m a little puzzled as if this is the right thing to do. I know I want to feel good, but I don’t want for time to pass by and not do something to get back on the road towards that PhD, and it would be nice to include such activities, and since the last month I’ve been feeling troubled twice a week, I just don’t know if this is normal or I am losing it again. I’ll appreciate your input. Thanks.I would love to be able to fix things entirely and feel for certain that this man is in fact in love with me.

It seems as if you have made an improvement. Your therapist seemed to agree otherwise she may not have been okay with you terminating your treatment. Your PCP has also agreed. He noted specific positive differences in your mood and behavior.

Your concern, as I understand it, is that you’re not certain if your improvement is sustainable. You worry that your depression may return. The primary reason for your concern is that at least twice a week you experience depression symptoms to the point where you want to cry and you call the psychiatrist’s office for his or her advice.

This is a difficult question to answer. My concern is that you have stopped seeing your therapist. I would not have recommended this. Some people believe that because they are doing better they no longer need treatment. Improvement is a sign that the counseling is likely working but not necessarily a reason to end treatment. My sense of the situation is that perhaps you have discontinued therapy too soon. Here’s why I say this.

You are taking on many new responsibilities (e.g. working on a paper that you hope to publish). These new tasks are very important for your growth and development but they can be anxiety-producing. This would be true for anyone but especially for someone with a history of anxiety and depression.

You also want to return to teaching, which is good, but it may be too much for you at this time. Again, it is difficult to know if that is true because you lack an objective source to help you determine if it’s too much for you at this time.

The point is that you don’t want to overwhelm yourself. Taking on too much could potentially cause a relapse and you don’t want that. It is important to work at a pace that is reasonable and does not overwhelm you.

My recommendation is to return to therapy. Your therapist was supportive in the past. You improved when you were working with her. She can help you manage and assess your new responsibilities. She can advise you as to whether you are taking on too much, too fast. It would be helpful to have someone like this in your corner while you’re adjusting to your new responsibilities.

It is often best in a situation like yours to gradually decrease your therapy sessions. When all is going well with your weekly sessions, for a period of time, then moving to one session every two weeks would be the next logical step, then once a month and so on.

With regard to mood, it’s best to aiim for a normal fluctuation without extremes. One should not be manically happy or desperately sad.

Life is difficult. There will be suffering and there will be happiness. Some days will be better than others. In the words of Viktor Frankl “what never can be ruled out is the unavoidability of suffering.” We should expect it, learn to deal with it and perhaps even find meaning in it.

Moods can be affected by hormones. Hormones are something that we cannot control. Moods are also affected by a lack of sleep as well as other factors. Tired people may have trouble managing their moods. It is important to recognize this.

When you sense an oncoming bad mood, try to ask yourself the following questions:

  • Why am I feeling this way?
  • Is this a reasonable way to feel?
  • Do I have any reason to feel this way?
  • Is it logical to feel this way?

Some of these answers may help you to better understand why you feel a particular way. When a negative mood arises, try to eradicate it using logic. Don’t allow yourself to be in a bad mood if there is no reason for it to occur. Logic will not work every time but it may prove helpful some of the time. If there is a legitimate reason for a negative mood, try to work through it to diminish it. What’s good is that you have begun to record your moods. This may help you to better understand them when they arise. You may see a pattern.

I hope this answer helps in some small way. I wish you luck in all of your future endeavors. Thanks for writing. I wish you well.

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Continuing Symptoms Despite Treatment

by Kristina Randle, Ph.D., LCSW April 27th, 2024
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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Terrible Home Environment

by Kristina Randle, Ph.D., LCSW February 10th, 2024
written by Kristina Randle, Ph.D., LCSW

Hi, im 17 year old and I live in what I call a hell hole with my dad, twin brother, step mom, and half siblings. I’ve always had problems living with my dad but it all went south when my dad got married. He started believing that people were trying to kill him with voodoo and so he married this woman a year ago to “protect us”. Then he started accusing me of stealing her stuff, using her stuff without permission, and even trying to kill him. He says that my mom (who lives in a different state) and I team up to put things around the apt to cause harm.

I am severely depressed and I was hospitalized a month ago after I called a suicide hotline and told the lady what I wanted to do to myself. And the only I called the hotline was because I repeatedly told my dad about my suicidal thoughts, and how depressed I am, and he said to leave him alone and if I wanted to continue to cut, I could until I bleed o death and he’ll just take me to the hospital. He moved over this past summer without telling me or my brother (we were at our mom’s house) so I have no one to talk to here.

The house is soo dirty, not just clothes and dirt…its like waste. And food, garbage all over this house, it makes me sick literally…im having stomach issues because don’t want to go to the bathroom, or anywhere else in this place. Im so scared of it..Im a germaphobe and so coming home after school makes me soo anxious and I want to cry. After I came home from the hospital..they gave me this discharge plan and I was put on medication there because of an anxiety attack. theyre antidepressants..welbutrin and because of my mood swings they mentioned mood stabilizers but said i will talk about that with an outpaitian psychiatrist.

The discharge plan said that I was to be placed in an intensive out patient program, and that didn’t happen because my dad says its stupid….2 weeks before my medication was finished I told him that and he just ignored me and so now my meds are done and it’s been a week. He doesn’t seem to care that I need a psychiatrist to monitor my meds. All I get here is threatened like “im gonna break ur neck”, “u’ll see what ill do to you”, “leave and don’t come back” name called like stupid, idiot, useless. I cant stay here anymore, I know im almost out but this is too much..the more I stay here the more suicidal I get and the more I want to cut. i still have mood swings and go into rages and its really bad and thats when i get the most threatened…i just feel like im getting worse…im really jumpy, always anxious..i dont have intense flashbacks anymore but alot of things bring me back and i tell my dad this and he doesnt care..he even said he doesnt
Do I even have any options as a 17 y/o? i really need a psychiatrist…Please help me..thank you for your time.

You are a very brave and resilient individual. I am very sorry to hear about the hardships you are facing on a daily basis. It sounds very difficult. I can understand why you feel anxious, depressed, and physically sick given your situation. Anyone would feel a similar way when faced with the same reality. It is clear that you are in need of help immediately. Below I have a list of possible suggestions for you that may help in your situation.

Contact the outpatient psychiatrist via phone or the mental health workers at the hospital who provided you a discharge plan. Tell them that you need help. Inform them about your home situation. Tell them about your father and the things he says to you. It seems as if he may possibly have a psychotic disorder. He is threatening you. He is not stable. He is paranoid. Tell them about your home living environment and how unsanitary it is. They may not know the full extent of your living situation. If they did, then I wonder how or why they would’ve placed you back in the home. If they knew more about what you’re currently going through, then they may be able to help you move out of the environment and into a more stable and clean home. They could place you in a residential treatment facility or related facility where you can gain relief from your situation. Your mental health is not only at risk but so is your physical health. This is a serious situation.

Another consideration is going to live with a relative. Is there anyone in your family you could live with, at least temporarily? If not a family member then what about a friend?

If none of the above options are helpful then I would strongly suggest speaking to someone at your school. You could speak to a trusted teacher, the school principal, the school nurse, or any other individual in the school who may be able to help you. If not someone at the school, then is there anyone you could speak with at a local church? That is also a consideration.

One last option to consider is calling Child Protective Services. I do not know your location or I would provide you with the phone number but you can generally find the phone number to Child Protective Services in the yellow or white pages. You may be able to do an Internet search. Type in the words “Child Protective Services” and the name of your city or state in a Google search and you should be able to find the phone number.

The bottom line is that you need immediate help. It’s not going to be easy to handle this situation on your own. I would not recommend it. You need outside help ideally from mental health professionals. If you are feeling suicidal then you should call a crisis hotline or go straight to an emergency room. Here’s a number for a crisis hotline: 1-800-273-8255.

Please consider making contact with one of the resources mentioned above. Inform them about your current situation. Be certain that you provide details, especially about your current living situation. They need to know that your home, as you have described it in your letter, is a major health hazard. I hope you’re able to find the help you need. Please write if you have any further questions.

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Is There a Way to Decrease Side Effects Without Stopping Meds?

by Kristina Randle, Ph.D., LCSW October 8th, 2023
written by Kristina Randle, Ph.D., LCSW

Q. I’ve been on Effexor for the last three years, with lots of success. After fifteen-plus years of trying all the antidepressants on the market with no results,I’m happy that this medication has almost eliminated my depression and anxiety. However, I have side effects that are difficult to live with. I am always too hot, feeling like my blood is boiling, despite my skin feeling cool. At night, I have to change my pyjamas 3-5 times before morning, with night sweats so bad I can literally wring out my clothing and my hair. My sheets and pillow are often soaked through, and I have to lay towels down on my bed in order to go back to sleep. I’ve had bloodwork done several times, but all my tests have come back normal. I’ve tried decreasing my Effexor, from 187mg to 150mg, but it didn’t help, and only caused withdrawal symptoms. Is there any way to cool my body down from the inside out, other than stopping the Effexor????? It’s going to be a VERY long summer if you can’t help me!!!!! Also, while the Effexor has helped with my depression and anxiety, I’ve found I don’t really have any emotions. Except for anger when dealing with my family, I’m pretty much “numb” inside. I can laugh at jokes or funny stories, but the “happiness” doesn’t last. I can be sad when I see stories of animals or children hurt, but the “sadness” never seems to really get to my heart. I feel like the meds have left my heart empty, and I’m just “going through the motions” of living. Sure, I’m alive, but I feel like I’m just “exisiting” rather than “living”. Is there any way to fix this, WITHOUT me having to go off my lifesaving medication????

There may be little that you can do with regard to the bothersome side effects if you’re not able to stop or switch to another medication. You stated that you tried to decrease the dose and ended up suffering from withdrawal symptoms. You also said that you have tried all of the other available medications. You could keep working with your doctor to try smaller, more gradual decreases in the medication but you may not want to do this if you cannot tolerate the withdrawal symptoms.

What about therapy? Have you tried to address the issues that led you to begin taking antidepressant medications?

It is not uncommon for people to say that while they feel better on the antidepressant medication they also feel “numb.” People who take antidepressants often describe a decrease in their depression symptoms but find it difficult to feel happy or to feel much at all. This seems like what you might be experiencing.

You could try therapy in conjunction with medication. When and if you start to feel better with therapy you could try to decrease or eventually stop the medications, guided by your doctor. This process of getting better through therapy and titrating down or off of the medication will not happen overnight. It might be a matter of months or years before you would be able to completely stop the medication using therapy as your only form of treatment.

If you’re not interested in therapy and have no intention of decreasing or eventually stopping the medication then the side effects and emotional numbness that you feel may be something you’ll have to live with. You’ll have to decide if this is a trade-off you’re willing to live with.

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Sick husband beats her all the time

by Dr. Marie Hartwell-Walker May 10th, 2023
written by Dr. Marie Hartwell-Walker

We have been married to most of our adult life. He is controlling and very violent. I’ve left him more than 45 times but I return because he always gets sick, once he had a stroke and fell down the stairs and broke his hips. He is in pain all the time and there isn’t any meds that will help the pain. Since he has brain cancer, diabetes and broken hips he is never in a good mood, therefore everything I do is wrong. He is a pefectionist. I’m depressed all the time and I can’t walk without stumbling because I’ve been hit on my head so many times, I have dents in my head. I can not find a way to ensure that he has food to eat and someone can take care of him. He won’t go to a nursing home and he wants to die at home. He has to eat or he will vomit. No one has keys to his house but me and when he can’t talk, the blood doesn’t get to his brain, no one can understand him but me. I’ve thought of everything I could not I don’t see any way out. I work and he doesn’t but he’s very intelligient, smarter than me. He could fix anything and knows almost everything. I know I could live up to his standards. He complains that I don’t cook, take care of him or talk to him to get his mind off his pain and him dying. All I want to do is to sleep to escape being with him. Work and sleep are my escapes unless I leave him then he calls me all day at work and threatens to have me arrested for theft of his cell phone. I’m desperate, I have talked to dv counselors and I still can’t find a way out.

What you are describing is domestic violence. Please don’t give up on the counselors in your area. Here’s a quote from the website for the Indiana Coalition Against Domestic Violence: “CADV operates the statewide 24-hour toll-free hotline for victims of domestic violence in partnership with Alternatives Inc. of Madison County. Individuals calling the crisis line receive emotional and practical support that includes, but is not limited to the following: crisis counseling, criminal justice information, personal advocacy, information and referral services, and violent crime compensation assistance.” The CADV Hotline is 1-800-332-7385.

You need to be in touch with these people to get needed moral support and to help you understand how to get out of your situation. I realize you’re trying to do the right thing and not abandon someone who is sick and in pain. But being sick does not excuse your husband’s treatment of you. Nor does it require you to be his nurse when his response is to hurt you some more. You are beaten down but not out. You may be depressed but you managed to write to us here at LifeHelper. Now make some calls to CADV and get the help you deserve.

I wish you well.
Dr. Marie

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Fearing hospitalization

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

I’ve had severe depression for quite a while. I started receiving treatment (meds and counseling) a little over two years ago. I had some success and got my depression under control, to the point where i didn’t need meds. But over the last 6 months, my life has fallen apart. I’m back on the meds (even though I didn’t want it) and in counseling every week. My therapist is helpful and while i trust him, i feel like i’m not able to tell him everything that is going on. For the last month or so, I’ve had serious suicide ideation. I told my therapist my plan, but promised I wouldn’t act on it that week. But each week it’s getting harder and harder to make that promise. As the stress of the end of the semester builds up, suicide seems more and more like the answer. In my session yesterday, my therapist got worried because I had a difficult week dominated with suicidal thoughts. He said that I should consider hospitalization. But that scares me even more. I know I should do whatever needs to be done to be kept safe, but I can’t go to the hospital. No one knows how bad i feel and it would devastate my parents and family if they found out. I’m not sure what to do… Truthfully, I am scared of what I might do, but I think I’m more scared of what happens when my family finds out… What do you recommend?
Thanks for listening.

I’m sorry you are having such a difficult time. I hope you can hold onto the fact that treatment helped you before. That is the best indicator that it will help you again. But — your therapist can only help you if you let him. We therapists aren’t mind-readers (although sometimes we really try hard to be). You do need to be straight with him.

However devastated your family would be if you go into a hospital, I’m sure you know they would be far more devastated to lose you. Yes, it is hard for many families to come to terms with someone they love being in such emotional trouble that it takes a hospital to keep them safe. But bottom line, they do want their family member to get the help he or she needs. Often family members relax once they realize that psychiatric hospitals aren’t like what is often depicted in movies and on TV. Good hospitals simply provide structure, some intensive therapy, and a safe place to work out the right medication for the patient. Often, there is a family therapy component to help family members know how to be more helpful and supportive. You can give your therapist permission to explain to them what a hospitalization is like and what could be accomplished there.

I think you’ll find that you will feel a little better just by finally making a decision to go ahead and allow an admission. Once that big decision is made, you can turn your attention to dealing with the depression – which is the point, after all.

I wish you well.
Dr. Marie

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Ex vs. Kids — Who to Believe?

by Kristina Randle, Ph.D., LCSW July 2nd, 2021
written by Kristina Randle, Ph.D., LCSW

I sent in a question about this issue a little over a year ago and have received a useful response that I thought was workable. However, the situation is still not resolved. I’ve been divorced from my ex over five years. He has two domestic violence felonies and has been incarcerated for domestic violence (against me). Since his release from jail more than five years ago, he has sought community based mental health counseling. He’s been diagnosed with bi-polar disorder, PTSD, and OCD. He’s on social security disability. I still love him. But there are a number of issues: 1) He claims he’s no longer mentally ill and only takes his psychotropic drugs shortly before he’s scheduled for his monthly appointment with his psychiatrist. The rest of the time he doesn’t take his meds. 2) He’s isolating himself in a very messy apartment, has grandiose ideas about rewriting the Bible, believes in all kinds of conspiracy theories, and engages in magical thinking; for example: he’s more enlightened than other humans because of his spirituality. 3) He is pushing me to let him come back to me again despite my three grown son’s objections. My youngest son (now 28) is in counseling also for PTSD because when he was a child (from the age of 10) he has witnessed his stepfather’s (my ex-husband) abuse toward me. My ex tells me if I really loved him I wouldn’t leave him, that in the eyes of God we will never be divorced, and if I did decide to move on without him I would betray him like everybody else in life. When I tell him about my sons’ objections he says they should get over it, and that I shouldn’t allow them to control my life. 4) I have forgiven my ex, but feel he might be playing on my emotions. I’m afraid if I allowed him to live with me again he might become abusive again. 5) Most importantly, I’m torn between loyalty to my sons and loyalty to my ex. I have a good and loving relationship with my grown sons. I feel my relationship with them will suffer if I go back to my ex who is diagnosed with mental illness but is noncompliant in taking his meds regularly because he feels he’s no longer sick. My sons want my ex out of their lives and out of my life. I feel torn between my family and my ex.

I would concur with your sons who contend that reconnecting with your ex is a bad idea. To paraphrase Maya Angelou: “people always show you early on who they are and if you don’t hear it, it is because you are just not listening.”

Your ex has a history of abuse. History of violence is the most reliable predictor of future violence. No one can predict for certain if he will abuse you again but the fact that he is noncompliant with his medications and is currently experiencing symptoms of psychosis significantly increases the likelihood of violence.

It is often difficult for an individual to control their behavior while they are actively psychotic. By definition psychosis is a break with reality. In other words, individuals who are psychotic have difficulty distinguishing what is real and what is not real. Their judgment is significantly impaired. His misinterpretation of reality could result in violence.

If you choose to reconnect with your ex, then you should do so slowly and with strict boundaries placed upon the relationship. For instance, don’t allow him to return to your home until he has at least at least six months of proven medication compliance and there is clear evidence that his symptoms are under control. He’d have to prove to you that he is taking his medication on a consistent and daily basis, not just in the period before his psychiatry appointment.

Given the information provided, I would not advise you to continue your relationship with your ex. He is not mentally stable, he is noncompliant with his much-needed psychiatric medication, he has a history of violence towards you, and you already suspect that he may be manipulating your emotions. However, I understand that my knowledge of your situation is limited. There are likely many more details about the relationship that were not included in your letter. It would be advantageous to meet with a therapist to discuss your situation in further detail. A therapist could gather the necessary information to objectively evaluate your situation, and assist you in making the best possible decision about how to proceed.

Please take care. I wish you the best of luck.

Dr. Kristina Randle

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Define Bipolar Spectrum?

by Kristina Randle, Ph.D., LCSW May 3rd, 2021
written by Kristina Randle, Ph.D., LCSW

I have suffered with depression a lot in my life. I have been on and off meds and it keeps coming back. I told my family doc and she tried different meds and still it seemed to work for about a month and then nothing. She put me on the maximum amount of wellbutrin (450mg) and .5mg klonapin and said she thinks I need a mood stabilizer so I contacted a psychiatry practice to try and understand this more.

I have horrible mood swings, I get irritated very easily. I start the day feel great, I get my cleaning done, play with my kids and then i start to get irritable and depressed which just leads to more irribility and frustration because i can’t stop feeling angry and depressed.

My doc appt yesterday i reviewed my family and self history. It was extremely difficult to talk about everything but i told her that i go between depression, irribility, anger, anxiety to feeling like i can take on anything (more creative/clear thoughts).

She told me i definitely fall somewhere on the bipolar spectrum but never explained that. What does “falling on the bipolar spectrum actually mean?” Does it mean I am actually bipolar? What is the bipolar spectrum?

Your doctor may have used the phrase “bipolar spectrum” because she believes that you have bipolar disorder but is not sure which type. The three main types include bipolar I disorder, bipolar II and cyclothymic disorder. Bipolar I is considered the most severe and cyclothymic disorder, the least severe.

Individuals who have bipolar I disorder experience episodes of mania. People with mania feel euphoria, grandiosity and emotionally “high.” They can also feel irritable. Their mood shifts rapidly. They can feel euphoric one moment and then quickly feel depressed and angry. Their behavior is erratic and they often behave in irresponsible ways. Psychosis can also be present.

Individuals who are diagnosed with bipolar II also experience mood instability but not to the same degree that occurs with bipolar I disorder. Typically, more depressive symptoms are present than hypomania symptoms.

Cyclothymic disorder is a chronic mood disorder that is present for at least two years. Like bipolar I and bipolar II, it is characterized by fluctuating mood disturbances and hypomania but the symptoms are less severe and less frequent. Many consider it a milder form of bipolar disorder.

You take medication for your symptoms but that is not enough. Psychotherapy is an important treatment for mood disorders. Medication can stabilize your symptoms but psychotherapy allows you to address the underlying problem. You found it difficult to detail your family and self-history which tells me that you have yet to address the emotional pain that may be at the heart of some of your symptoms.

I would recommend psychotherapy. Please consider it. Comprehensive psychological treatment involves both psychotherapy and medication. I wish you the best of luck.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

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Random, Unexplainable Emotions

by Kristina Randle, Ph.D., LCSW April 4th, 2021
written by Kristina Randle, Ph.D., LCSW

For the past two years or so I have noticed my emotions are altered randomly, either for some insignificant reason, or no reason at all. My emotions tend to cycle in order from being generaly content, to a lethargic, unmotivated, depressive “my future is hopeless no matter how hard a try” way of thinking. It takes a toll on my current relationship. My boyfriend and I have been dating for a bit over two years, and he says I haven’t always acted this way. It’s hard for me to take note of my own emotions, because I feel that they are norma, and logical. I often become upset about something random my boyfriend says or does (or doesn’t do, in some cases). At the time, I feel like I’m being completely rational. But in the morning, or about a day later, I realize how ridiculous I was acting. Unusually, I can’t even remember why I was upset in the first place. This just happened today, and here I am about 12 hours later, and I can’t remember why I was upset with him. It’s very stressful for my boyfriend, and it’s upsetting for me as well because he really shouldn’t have to deal with this kind of stress, and I feel my random crying and melancholy emotions are really unnecessary.

Also, my mother recently told me that not only was she diagnosed with GAD (general anxiety disorder) and taking meds, but her mom also has panic disorder. This is what really concerned me, because I learned that those kinds of things give me a higher chance of forming similar mental issues. I’m not claiming that I have a mental illness, but I think it’s safe to say that I should be aware of my genetic predispositions.

I’ve recently visited a doctor for a checkup and refill of my meds (asthma and allergy). I was intending on talking to him about my concerns, but I decided last-minute that I was fine, and I’m just making a big deal about nothing. I kind of chickened out, because I couldn’t remember what exactly my concerns were. Another strange behavior I just remembered is that I tear up whenever someone talks to me seriously. My professor was talking to me about an assignment I was having trouble on, and I guess because I was grateful that he cared about my wellbeing enough to talk about it with me outside of class, I started to tear up, which was extremely embarrassing. I wasn’t sad, nor was I so grateful to him that tearing up would be acceptable. I do the same thing with my parents, and boyfriend. It’s quite frustrating, especially with someone I don’t know.

Also, recently I experienced a week of random sexual arousal. There was no reason for it, and I’ve never experienced it that severe before. I couldn’t concentrate in any of my classes, or on anything else for that matter. It just yesterday receded enough for me to get something academic done.

In a nutshell, if all of that was confusing, I am concerned about my random, often irrelevant emotions. It’s taking a toll on my relationship, as well as my motivation for getting things done. When depressed, I feel that my future is hopeless, but I’ve never been depressed enough to wish for death. When I’m in my happy mood, usually after I’m done menstruating, I’m just generally happy. Not hyper, just happy. Although I take a lot of things jokingly, I still don’t have enough energy to run around. I just want to know if I am normal, or if I really do have a reason for concern. I take the sanity test, and it showed concern about mania and bipolar disorder. Anyway, apologies if this was a bit much. Thanks.

It is possible that the emotions you are describing are random but generally there is a reason behind our feelings. The reason may not always be evident or easy to identify. That can be a challenge. If you keep track of your thoughts and feelings you may discover a pattern or trend. For example, you might notice that you begin to experience unexplainable emotions a few days prior to your menstrual cycle. It’s not unusual for women to experience “random” emotions right before their menstrual cycle begins. This is called premenstrual syndrome (PMS). A characteristic of PMS is mood swings. That might explain why once your menstrual cycle ends you feel happier. Think of PMS as a time when emotions are exaggerated. Many women describe feeling overly emotional at least a few days a month. Some women experience PMS more strongly than others. For women who have extreme PMS they are sometimes diagnosed with premenstrual dysphoric disorder (PMDD). This condition is associated with severe depression and irritability before a menstrual cycle begins.

The fact is that women have an extra challenge when it comes to dealing with their emotions and the reason is often the result of hormonal changes related to menstruation. Men do not have this challenge. They do not experience the same type of hormonal changes. Once you recognize this biological fact, you may be better able to manage the unruly emotions when they occur. Generally speaking, we cannot control our emotions but we can control our reaction to them.

How can you better manage your emotions? One way is to use logic. Emotions and logic are like oil and water. They don’t naturally mix unless you force them to. Using logic to manage emotions is not always easy and it does take practice, but it can be done. When you feel an emotion that seems random, try to analyze it. Examine it and try to understand its origin. If there is no logical reason behind it, recognize that it may be related to hormonal changes and let it go.

Also recognize that being tired can cause emotional instability. This is true for everyone, not just women. If you feel irritable for “no reason” recognize that it may be the tiredness that is causing you to feel a certain way. Acknowledge this and try not to let it rule the way you feel. The idea is to get into the habit of analyzing your emotions, trying to determine their origin, deciding whether they are legitimate and not letting them control your mood.

On the other hand, the emotions you have described may not be the result of PMS. There may be another explanation. It’s possible that you may be experiencing depression or anxiety, although much of what you’ve described is not characteristic of an anxiety disorder. It’s more characteristic of PMS. This is especially true when you described having random sexual arousal. It’s common to have an increase in libido near or during your menstrual cycle. Again, this is often related to hormonal changes. One theory is that because there’s an increase in blood flow and lubrication during the menstrual cycle this heightens sexual arousal.

As I mentioned before it might be helpful if you began a journal to document your thoughts and feelings. You may find that your emotions are in fact not random and occur right before or during your menstrual cycle. The likely explanation therefore would be PMS. If your random emotions continue to be a concern for you, you may want to speak to your doctor about your symptoms. He or she may be able to prescribe a medication that could help you during these times. If the symptoms are severe enough some women choose to take birth control as a way to manage their mood. Some also take an antidepressant. I would not recommend either of these for you specifically because I have so few details about your problem, but meeting with a doctor to further explore your situation may be helpful. Thank you for your question.

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Chronic Anger & Anxiety

by Kristina Randle, Ph.D., LCSW March 29th, 2021
written by Kristina Randle, Ph.D., LCSW

I am a 21 year old male and for as long as i can remember i get so mad i break everything i own nomater how valueable it is. Ive been in psych counceling, tharapy, and on more meds than i can count ever since i was 13. Ive been diagnosed with ADHD, Major depressive disorder, and anxiety. I feel scared all the time and cant really go anywhere or do anything with people, I dont know why but im scared of pretty much everything. Its extreamly hard to focus on anything and if things dont go how my mind thinks its gonna go i pretty much break down and have no idea what to do. I dont really have any friends and cant get a job because i fear talking to people or approaching people i dont know. Life for me always feels like 1 step foward and 2 steps back. I was in counceling for about 6 years and as stated been on so many differeny medications. Nothing ever felt like it took the pain or fear away. Im tired of living in what i would describe as “a personal war within myself” It feels like i can never let myself be happy. I just dont know what to do anymore ive been living with this hell for my whole life. I wasnt abused or anything like that. I had a good childhood with caring loving parents. I was an only child by the way. When I was 18 I went to jail for getting into a fight and while i was incarsarated I lost my grandfather who was my idol in life, the person i cared about most. Im sure that didnt help my mental health state. Even 3 years later i still lay awake at night sometimes thinking about it. I feel alone all the time and thats my biggest fear in life is being alone, i feel alone all the time. When im by myself at home i feel extreamly depressed and lonley. I feel like if i had someone with me life would be easier. Im a nice person who pretty much is always trying to help people out but for some reason people dont want to be around me. I just really need some REAL advice, seems like everybody tells me the same things to do with my anger, depression, and anxiety. I just need some real direction. thank you for your time.

It is important to realize that psychological pain can be eliminated from your life. It’s often a matter of finding the right therapist and combination of medications. You have been in therapy for a number of years but it does not sound as though you have found the right therapist to help you. I would recommend continuing to try.

How will you know if you’re being helped in therapy? You should feel as though the therapist “gets it.” You should leave every session feeling a little better. You should feel a connection with your therapist. You should feel that the therapist understands you.

It is also important to understand that therapy can take years to be fully effective. Don’t give up. Many of the problems that individuals are dealing with are complex and may stem from childhood.

Two self-help books that I would recommend include The Road Less Traveled by M. Scott Peck and Man’s Search For Meaning by Viktor Frankl. I consider these books to be timeless in that they contain a great deal of enduring wisdom and address a wide variety of problems including anger, depression and anxiety.

I would also recommend that you consider an anger management program. There may be one in your community. Many are highly effective. You also might want to consider an anger management workbook. I hope that you’re able to find the help you are looking for. Please take care.

Dr. Kristina Randle

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Am I Clinically Depressed?

by Kristina Randle, Ph.D., LCSW May 27th, 2019
written by Kristina Randle, Ph.D., LCSW

I’m always depressed when I’m not around my ex. because he’s the only one who really gets me and knows me and really listens when I talk. When he isn’t around I have no one to talk to so I start thinking that everyone(my ex, my son, everyone) is better off without me. I never leave my bed or my house very much(online schooling). I wake up all night and I never wanna get up in the mornings. I hate the thought of people not wanting me around. I cry all the time! I hate myself a lot/most of the time. The only time I leave my house is family events or my ex convinces me to go somewhere with him. I’m always in pain unless I’m venting to my ex. I mean emotional and physical. I just ache all over. I want to get better and need to for my son and ex(we might get back together later on and he’s my rock and I’m his and if I’m sick I can’t be there for him like I’d like). My ex is the only one that I know who knows about me thinking I’m sick because I don’t want to go to the doctors and have them put me on meds or something. Am I clinically depressed? Should I ask my mom to take me to the doctor to get help or am I fine? I need to know!!

An in-person interview, with a trained diagnostician, would provide the most accurate diagnosis but depression may be a realistic possibility. According to your letter, your symptoms include: a desire to isolate, physical and emotional pain, low self-esteem, and the consistent urge to cry. Those are common signs of depression.

Your symptoms are interfering with your life and they should be treated. To answer your question directly, yes, you should ask your mother to take you to a doctor. Being evaluated by a doctor does not mean that you will have to take medication. Many people who are receiving treatment for depression don’t take medication. Instead, they undergo counseling. With the right therapist, counseling is an effective treatment modality.

What are your next steps? Speak to your mother. Tell her about your symptoms. Ask her if she will schedule an appointment for you with either a primary care physician (PCP) or a local therapist. Consider seeing your PCP first to rule out possible medical problems. The PCP can then refer you to a therapist. If you choose not to see a PCP, the “find help” tab, at the top of this page, can help you to locate a therapist in your community.

The best way to find the right therapist is to call at least four or five and ask them various questions, including:

  • Can they help you?
  • How exactly would they help you?
  • What would they suggest that you do?
  • Would they be willing to see you and if so, how soon and how often?
  • How long have they been in practice?
  • Have they helped other individuals with similar problems?
  • What were the outcomes of those situations?

Choose the therapist who you feel most comfortable with and schedule an appointment. I wish you the best. Please take care.

Dr. Kristina Randle

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Can I Recover From My Husband’s Psychosis?

by Kristina Randle, Ph.D., LCSW January 26th, 2020
written by Kristina Randle, Ph.D., LCSW

I don’t know how to recover from my husband’s psychosis. My husband was psychotic for about a year. It began shortly before our marriage (I attributed his behavior to stress – he owned a business that has since failed) and continued through the birth of our child. The psychotic episode was almost certainly spurred by his use/abuse of prescribed amphetamines (70m Vyvanse a day, 20m Adderal “as needed”) but the psychosis persisted for several months after he stopped the meds.

In addition to his business failing, I lost my job due to frequent absences attributable to his psychotic episodes, and insurred substantial debt. I may lose my house as I’ve had to relocate for work and may not be able to rent my home. He verbally abused all of my closest friends, whose friendships I subsequently lost, and even assaulted me one night, for which I had him incarcerated.
He is substantially recovered now (no voices, the paranoia’s dropped, less referential ideation) but I find his behavior odd, and it angers me. Actually, it enrages me. He worships me, but I am not sure if it is because I am his lifeline (his mother’s very selfish) or if he genuinely loves me. It doesn’t matter, anyway, because I am repulsed by him. I would say that I hate him except that I feel too sorry for him to hate him.

Should I even try to repair this situation? If so, how? Is bailing on him unfair? Sometimes when I think of all he has cost me I feel like I am going to fly into a thousand pieces I become so angry.
How do I recover from my husband’s psychotic episode?

What happened to your husband was an accident, just like a car accident. He was taking prescribed psychiatric medications under the direction of a physician and he became psychotic. He did not purposely become psychotic. The damage caused by his psychosis has been extreme in your life and his but that was never his intention. It seemed his intention was to try and receive help. The outcome was not within his control.

When someone is in a physical accident they suffer from the consequences of the accident and the family also suffers. It is not unusual for someone to feel the way that you do. Commonly mental illness is viewed in a different light than physical illness. This may be because physical illnesses are seen as not being within one’s control. Mental illness, on the other hand, is often perceived as being controllable.

Here is a very common scenario: An individual reveals to his or her family that he or she is depressed. The family responds: “get over it, “just snap out of it,” “it’s just a phase” or “you are just looking for attention.” There’s often no support. The implication is that the family believes that mental illness is controllable; after all, their suggestions are for the individual to take control. Alternatively, if a family member revealed that he or she was just diagnosed with cancer or had their hand cut off in an accident, in most cases the family would respond with sympathy and empathy.

It is important to keep in mind that one does not choose to be mentally ill. It is not appropriate to be angry at someone for being mentally ill. An individual has no control over the development of mental illness.

Among individuals with schizophrenia, for instance, part of their illness causes them not to be able to recognize that they’re ill and subsequently many don’t take their medication. Family members become very angry that their loved one doesn’t recognize their illness and refuses their medication. The reality is that the illness robs many individuals with schizophrenia of their ability to realize that they’re ill. Anger in these situations is perfectly understandable but it’s misplaced because no one chooses to be mentally ill.

You say that your husband has changed. He is also improving. It may be simply a matter of time before he returns to the man that you married. What happened to him was tragic for him and also you. You are both victims of his illness.

You married him for some reason. There was something that you loved about him. He has changed; people often do so in a relationship. When your partner is no longer the person that you married, many people reevaluate their relationship and some choose divorce. Your husband has changed because of his mental illness. He is no longer the man that you married. He may return to the person that you married but he may never again be the same. Marriage is a commitment. Some believe that is a lifelong commitment. Some believe that the commitment extends beyond this life and into eternity. Others believe that marriage should only continue until you become dissatisfied and they fully see divorce as a part of life. Divorce is a moral decision. Each of us must make that decision.

Before considering any major changes to the relationship I would strongly suggest that you seek counseling. Therapy can help you navigate your situation and also assist you in dealing with your intense feelings of anger. Click on the find help tap at the top of this page, to help you locate a therapist in your community. Please take care. I wish you the best.

Dr. Kristina Randle

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My illness ruined our relationship

by Dr. Marie Hartwell-Walker April 20th, 2019
written by Dr. Marie Hartwell-Walker

I’ve been in a long distance relationship with my boyfriend for a little over a year. When we first got together our relationship was perfect. We had been friends for awhile and decided to take it to the next level. He was attentive and loving and made me feel special. He would go out of his way to do things for me or spend time with me. I had been in a lot of bad relationships in the past and before we got together I had been single for a little over two years. The lessons learned from those past relationships helped me to see where I was going wrong and to learn to be happy alone instead of constantly seeking someone to fill some void. I’d gone so far as to make out a very long list of the things I needed, wanted, and wouldn’t mind having in a relationship. My current boyfriend filled almost all of them.

Eventually though issues in my life started to arise, health issues that he noticed. I had always had some that bothered me but no doctor had really been able to give me a diagnosis. My boyfriend just accepted that who I was was who I would always be. He talked me into going in search of a doctor that could tell me what was wrong and eventually we did get a diagnosis and meds to help. That was the turning point in our relationship, when he found out that part of who I was was changeable. That there was actually hope that we could fix it.

That part of me is my weight. I’m not obese but I am over weight and it has been something I have struggled my whole life with. I work out, go to the gym daily, eat healthy yet never seem to lose. Before the diagnosis of Polycystic Ovary Syndrome he just accepted that my shape was set in stone but now that he sees it’s not, he wants me to change it.

We’d had so many talks about me moving to be near him, moving in together, getting married. At the beginning he was even begging me to come see him all the time. Now that’s all changed. It’s gone from “come this thanksgiving” to “We’ll see how things go”, from wanting me in his life to telling me I need to be in shape before I get there because he’s just not attracted to bigger girls.

On top of that he’s stopped spending time with me, I have to beg him to drop what he’s doing to make time for me in his life and he always acts like it’s a sacrifice. I feel guilty for even asking. When I bring these things up to him he’s genuinely sorry and feels terrible. He makes promises to change and says he wishes he were a better person but nothing ever does change. It just keeps going and I keep feeling terrible and unloved. I’ve started to question sometimes if he really loves me or not. I’ve doubled the time I spend at the gym, gone on a stricter diet, taken all the meds and advice my doctor can offer but I still worry about his conditional love. Is it even the right move to cater to it at all? Isn’t real love worth working for but what is too far? And what if one day something happens and I gain the weight back (assuming I manage to lose it all in the first place), will he still love me or will he suddenly lose his attraction for me?

I love this man very much. He is almost everything I have wanted to find in a man and I can’t picture my life without him. I’ve tried expressing myself, I’ve tried making the sacrifices, I’ve even tried being very pointed with my comments so he can see what he’s doing wrong when he’s doing it. Nothing has worked. I know you can’t expect a person to change themselves for a relationship but I don’t know how to fix this, what to say or do. And I do want to fix this.

You are asking important, important questions. You are also taking a huge amount on yourself. You say you know that you can’t expect a person to change themselves for a relationship but you don’t expect your boyfriend to give you the same courtesy.

It looks to me like you’re doing everything and more than can be expected given your diagnosis. I wish you success in your efforts to be healthy and strong. But healthy and strong doesn’t always mean being model-thin or even typical. From what I read, keeping your weight down is likely to be a challenge throughout your life. Do you want to always live with a “diet policeman”? Does he always want to be the cop on that beat?

Accepting your diagnosis means accepting all of it. For you, that includes doing what you can to work with your doctors and to continue to eat right and exercise to avoid the possibility of diabetes, heart disease, or high blood pressure. For your boyfriend, it means accepting that even when you are doing the very best you can, you are still going to have the medical problem and the issues that come with it. He needs to learn the difference between being encouraging and being demanding. If he isn’t attracted to bigger girls, you’re not the girl for him. Instead of making you feel bad about this, he should be looking at why he’s coming up with that issue at this stage in your relationship. Instead of feeling like there is something wrong with you, you need to be asking yourself why you would love a guy who is this unloving.

You can’t “fix this” on your own. I suggest you take a big step back from the relationship. Work on your own health and well-being. As you feel healthier, chances are you will also have more energy and more interest in a social life. You deserve someone who is going to love and cherish you – all of you. If he can’t come to terms with that, then your current boyfriend isn’t the guy for you.

I wish you well.
Dr. Marie

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Anniversary of Dad’s Death

by Kristina Randle, Ph.D., LCSW November 9th, 2019
written by Kristina Randle, Ph.D., LCSW

Saturday is the 1st anniversary of my dad’s sudden death. I have been the support person for my mom this year but it is catching up with me. This week I have been having bad thoughts of dying. I feel like why bother to do things, go to school, clean my house etc. I have been thinking about the end of the world in 2012 and figure why bother doing anything. I have been playing with fire with my meds because I just don’t care.

Will this feeling pass after I get past the anniversary? Is this normal for people to slip like this in this situation?

I live with bipolar and have been pretty stable for some time now. I just hope I get past this without doing anything stupid.

I am very sorry for your loss. The death of a parent is a significant life event. Dr. Elisabeth Kübler-Ross identified five distinct stages of grief that people experience when they are dealing with a loss or a tragedy. Dr. Kübler-Ross describes these stages in her 1969 book entitled On Death and Dying. Her model of grief was developed to help individuals cope with the death of a loved one. You may be experiencing depression, one of the five stages of grief.

Stage 1: Denial. During this stage, there is often a sense of shock and denial. People describe feeling emotionally numb. It is almost as if they don’t believe their loved one is gone. Denial is an unconscious defense mechanism. In this regard, it serves a protection function and it helps lessen the impact of the loss.

Stage 2: Rage and Anger. During this stage, an individual may wonder “why me? What did I do to deserve this loss?” It is not uncommon for individuals to become angry at the person they lost. They may think “why did you leave me?”

Stage 3: Bargaining: For many, this stage may include striking bargains in an effort to regain part of their loss. For instance, an individual may pray to God promising to do something good in exchange for a favor. “If I do this for you God, will you allow me to wake up from this horrible nightmare?” Even agnostics and atheists sometimes attempt bargaining with God during this stage.

Stage 4: Depression. This stage can bring about feelings of complete despair. At this stage, reality has set in. An individual begins to realize the enormity of their situation. Some people feel a deep sense of loss and think “how can I go on like this?” This is the stage I believe you may be currently experiencing.

Stage 5: Acceptance. By this stage, an individual can fully accept the reality of the situation. They are better able to cope with their loss. They are now in a position to work towards healthy alternatives to cope with their loss. For instance, an individual whose mother died of cancer may feel compelled to start a support or education group to help other family members who have lost a loved one to cancer.

Not everyone will go through all of these stages and some may get stuck in the earlier phases and never progress to the later stages. It is a idiosyncratic process that varies from person-to-person.

To answer your specific question, it is “normal” to feel the way you do. It becomes abnormal and considerably more worrisome if your intense feelings of despair linger or if they significantly interfere with your everyday life. In such a case, consider professional counseling. You could also benefit from a grief and loss support group.

I would also recommend reading about death and dying and other related topics. Many people who do so report feeling less grief associated with the loss of a loved one. They also report feeling more comfortable with life and death issues in general. Books that I would recommend include: Many Lives, Many Masters by Dr. Brian Weiss; Life After Life by Dr. Raymond Moody and The Wheel of Life: A Memoir of Living and Dying by Dr. Elisabeth Kübler-Ross. These books might assist you during this very difficult time in your life. Good luck and please take care.

Dr. Kristina Randle

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Daughter refuses help

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

My daughter (age 22) was recently diagnosed as bipolar. She had a major panic attack and was hospitalized for 2 weeks, which was very traumatic. After her release, she stayed on her meds and went to sessions with a therapist for a few weeks, but recently stopped taking all meds, and refuses to see her therapist. She seemed ok for a little while, but is not showing signs of mania again. If I say anything about seeking treatment, she accuses me of not understanding her and what is happening to her. She is very paranoid and worries about her safety all the time. I need to know how to talk to her and what to do to get her into treatment. Any suggestions??
thanks

This has to be very, very painful. Help is available but your daughter is too distressed to take it. She’s too old for you to have any authority and too young for you to have confidence that she will figure it out without getting into big trouble. It feels terrible to sit on the sidelines and wait for the inevitable.

All you can do directly is tell her that you love her; that you are worried for her; and that you are seeing signs that she is headed for trouble again. Emphasize that you aren’t judging her but that you want to help her catch the illness before she needs another hospitalization. Sympathize with how traumatizing the last episode was and about how hard it is to ask for help. As much as possible, it’s important to keep her in charge of what to do. When a person feels like their efforts to stay in control are slipping, the last thing the usually want is for someone else to take control away from them.

Your daughter’s clinicians can’t talk to you about her care unless she will sign a release. (It’s certainly worth asking her to do so but, since she is paranoid, it’s unlikely she will.) They can’t even confirm that she is their patient. But they can listen. You can call and tell them that you understand the limits of confidentiality but that you want them to know that the daughter you believe is their patient has stopped taking her meds and is anxious and paranoid. At least she is then on their radar. Since they know her, they will understand whether checking in with her would be a positive move or if it would make her more paranoid.

I also urge you to find a therapist for yourself, not because I think you are ill but because a professional can help you figure out what you can and can’t do. Further, you can then ask your daughter to join you in your therapy – which she might find less threatening than having you come into one of her sessions.

When a child is ill, the parent also suffers. I’m sorry that you are both going through this yet again.

I wish you both well.
Dr. Marie

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Eating disorder is eating up her life

by Dr. Marie Hartwell-Walker February 18th, 2019
written by Dr. Marie Hartwell-Walker

Do I have an eating disorder? I’m not really sure if i do or not. My dad always thought i did in middle school because i dont put my lips to my fork when i eat i use my teeth to “rake” the food off instead and i always thought that was crazy. At the time i was about five foot six and weighed about 130 wich i thought was a bit much until i saw myself in a full length mirror. now im a senior in highschool and im five foot seven and as of this morning im 144.3 lbs. I worked my way up to 167 last year and tried to get down to 140 for prom. I diddnt succeed and i ended up eating so much i gained 10 of the 20 lbs i lost and then over summer after i got diagnose with celiacs disease i diddnt eat very much, there would be days i just skipped food all together. everyday at the pool more and more guys would look and I felt more confident. when i went to my doctor for my celiacs doctor about a month ago, she said that my weight concerned her. apparently 140 is the lowest my body can be without being unhelthy and i weighed in at 142. I still didnt feel it was enough and about 2 weeks ago i discovered that if i take my adhd medicine everyother day not only can i slack off when i really want to but i get sick and then im not hungry. I went down to 140.2 for about 4 days and i felt like a fat kid. In gym I couldnt run as fast as normal and i was out of breath in no time, when we got back i looked in the mirror and saw how gross i looked. my boyfriend thinks im self destructive in ways other that not eating because he sees me eating apples and rice bars alot and thinks its the only healthy thing i do for my body since i stopped cutting.But he dosnt understand either way and dosnt seem to notice either way so i figure hes happy about thedirection of my figure. I couldnt get my meds to make me sick anymore last week so i stopped taking them and i just ate everything with sugar or chocolate or fat and went up to 147 and it freaked me out. Christmas eve i took my meds without thinking and like usual when i take hem i diddnt eat. a few hours later i got really sick but due to a childhood surgery im unable to vomit so i just dryheave and it hurts but im used to it. I diddnt eat untill christmas morning(yesterday) and i ate all day long. then thismorning i did my usual. I got in my yogapants and a bra and ran down to weigh myself. unhappy with being almost 5 lbs above goal i got off and looked in the mirror again. poking and pulling and shaking i decided that i need to get back down but mom handed me a bowl of oatmeal that im currently avoiding and thinking about flushing even tho im starving so i think ill take my meds again tomorrow so ill be at my goal before mybirthday on the 29th and then ill beable to decide if i need to loose more or not. i realise this cant benormal. making myself sick to avoid food instead of making myself purge it and actually eating so is it really an eating dissorder if i take vitamins to get my minerals and then skip a day here and there for food but i never actually purge it?if so how do i fix myself, im too scared to tell my councellor because she thinks ive made so much progress wih everything else i dont want to dissapoint her and shed probably want me to tell mom who would make me eat at the table again so she knows im eating… I want to be in the fashion and art world and food just makes me fat… not fashionable nor artistic but disgusting and lathargic and even with crunches and dieting i cant seem to look the way i want … i also feel that im unhelthy weight already because the chart for weight is based off hight and im prety sur my chest is probably about 15 or 20 lbs of my weight wich means id be at unhelthy weight already wouldnt it? I just stil dont like the way i lok tho please help me figure this out

Yes, you have an eating disorder. It doesn’t matter what you call it. You are obsessed with your weight and what you are and are not eating and you are treating yourself horribly. Starving yourself (even for a day), giving yourself the dry heaves, and misusing your medications is not the way to get in control. Eating sensibly and doing a reasonable exercise routine is. You might also be pleasantly surprised by how things change if you take the diagnosis of celiac disease seriously. Going on a gluten-free diet is challenging but many people who have celiac feel much, much better when they drop wheat from their diet. See a nutritionist if you need some hints for how to go about it. You just might be able to substitute a healthy management of a gluten-free diet for your unhealthy approach to eating.

If you want to be in the art and fashion world, focus on making art and designs. Professionals in the industry are far more interested in the quality of your work than the size you wear.

Please show your counselor your letter. She can’t help you unless she knows the honest truth about what you are up to. Please don’t worry about “disappointing” her. Professionals do know that progress is often a matter of two steps forward and one step back. It’s part of the process. And by all means, let your mother help you. Your overconcern with your weight is threatening your health and your future.

I wish you well.
Dr. Marie

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Why The Pressure To Be in a Relationship?

by Kristina Randle, Ph.D., LCSW May 3rd, 2019
written by Kristina Randle, Ph.D., LCSW

I am someone people would consider anti-social and I agree. I find it very difficult to speak to people, I have my entire life, and even my mother describes me as a quiet child. My personal life consists of the same routine. After work, I run between two and three miles Monday thru Thursday then I watch T.V. and fall asleep. Friday thru Sunday, I study and complete all my homework. I follow this same routine weekly, I pay all my bills online and normally only go to the grocery store when I am completely out of food, even then I might not go for 2 or 3 days. I started this routine about 6 years ago when I stopped taking all my meds. I was diagnosed with Bipolar disorder, I question this diagnosis. I am not happy with my life but I am content, somewhat. Recently, I feel myself feeling unusual; Iike my routine is no longer working. I feel like I am about to do something terrible, like I am barely hanging on. I have to remind myself everyday of the consequences of my actions and I question how long that will hold up. I feel like I am losing sympathy and compassion for people, everything, and myself. On top of that, people at work and my immediate family have been pressuring me about dating and having children. The truth is I have never been in a relationship, I’m still a virgin; I have turned down every man that has ever asked me out on a date. Working in an automotive plant, this can happen up to two or three times a day. I do not know why but I avoid all relationships even friendly ones. I cannot begin to understand why my mother and brothers want me to be with someone.

Why do they bother me so much about being with someone? Why is my routine not working anymore? I’ve never tried therapy but I’ve had psychiatric forcing pills down my throat when I was 17 and 18, can therapy help me? Even if I’m not sure what my problems are? I always hear so much negativity about people who are anti-social and the crimes they have committed, I’m I destined to end up as them; I’m I fighting a losing battle?

There is a difference between being labeled antisocial by others and having an antisocial personality disorder (ASD). Someone can be described as antisocial if they limit their interactions with people but it does not have the same meaning as antisocial personality disorder (ASD), as outlined in the Diagnostic and Statistical Manual (DSM) of mental health disorders. ASD is a chronic mental health condition that is characterized by not knowing right from wrong. Individuals with ASD also tend to get into trouble with the law, they can be violent, impulsive, and they generally express a blatant disregard for others. They also often have difficulty relating to others and their relationships can be dysfunctional. If you’d like to read more about ASD, please follow this link.

You may be not very social in the sense that you rarely spend time with others. You seem to avoid relationships. Some possible reasons for this may include fear. Perhaps you fear rejection or you have social anxiety. Social anxiety is characterized by an excessive and unreasonable fear of social situations. It can arise when an individual is worried that people may criticize or judge them. It is also a characteristic of schizotypal personality disorder.

Schizoid personality disorder is another disorder to explore. Hallmarks of this disorder are avoiding social activities where interaction with others may take place and not enjoying the companionship of others.

Another possibility may be that you lack the necessary social skills to be an effective communicator and this hampers your ability to relate to others. Additionally, you state that you’ve been a quiet person all of your life. Maybe you are used to being “the quiet one” and it is easier to remain in this familiar role. If you lived your life as an introvert, the thought of being more of an extrovert may be uncomfortable and frightening. It may also be that you’d rather be alone and do not prefer the company of others.

I am not sure if medication could help unless the reason you do not to interact with others is fear (i.e. social anxiety). Some individuals with social anxiety take antidepressants or anxiety medication and find them very helpful. On the other hand, if you do in fact have bipolar disorder (as diagnosed), you may find medication very beneficial. Perhaps the only way to know if medicine would help is to try it, under the supervision of a mental health professional.

I believe therapy could be very beneficial. If you are open to therapy, I would strongly recommend it. Here’s a website that may help you locate a therapist in your community.

Lastly, you also asked why your family is pressuring you to have relationships. I cannot know with certainty but I believe it may be because they are worried about you. Also, they probably do not want you to miss out on the many wonderful benefits that can accompany relationships. Therapy may be able to help you in this area and I hope you will consider it. Thanks for your question. I wish you well.

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Discouraged with the system and losing hope

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

Lately I feel like I’ve been getting kicked around and going nowhere. I was released from the psych unit at the hospital on Wednesday following a 12-day involuntary stay. My preceptor (psychiatrist) thought I might be a danger to myself and had me admitted against my will. Although I was having suicidal thoughts, I’m bipolar. This honestly happens to me all the time, and I was never in any acute danger. Obviously she didn’t believe me.

While I was in the hospital, I dealt with two separate psychiatrists who had totally different opinions of me and completely different treatment plans. The first guy didn’t even want to bother with me. He brushed me off in such a callous way that I was very hurt, even crushed. The second guy was more open-minded and thought it would be worthwhile to try me on an MAOI, which I have never taken before. He discontinued the wellbutrin I was taking on the assumption that my outpatient psychiatrist would go along with that plan (he even talked to him about it). On Friday, my outpatient psychiatrist said that he didn’t like the MAOI idea and that I should go back to the meds I was taking prior to hospitalization, except without the antidepressant. (Take a depressed person and remove the antidepressant… good plan.)

So what did my hospitalization accomplish for me? Well, it screwed up my schooling. Now I have to take a leave of absence, repeat my psych rotation, and delay my graduation by months. It also did nothing to change my mood. I’m just as depressed as I was before, but with an altered set of stressors now. There have been no promising changes in my treatment plan. I gave the docs over a week of my cooperation as an inpatient in the hopes that they could help me, but it now seems that the entire ordeal was a complete waste of my time and a rather disruptive/destructive force in my life. I can’t think of anything good that has come of this. Nothing.

I’m going into medicine. I’ve always had an interest in psychology. However, this experience has done nothing but leave me disappointed and disheartened. Disappointed that those who are providing my care can’t agree with each other. Disappointed that I would be callously brushed off when I am in genuine pain. Disappointed that one would get my hopes up, and another would put me right back where I was before. Disheartened because when I finally made myself vulnerable and accepted a need for help (like frequent suicidal ideations maybe aren’t normal or healthy), I received three different responses and have made no progress whatsoever. Disheartened because I’m starting to feel like I can’t be helped (or at least no one wants to try). Now THAT’S depressing.

A recommendation has been made for therapy, and I’ll agree that I need it, but I don’t want to put all of my eggs in that basket. I’ve done therapy before. Years’ worth, and it has only been a moderate help. I know I don’t handle stress well, but my history includes bouts of major depression even when everything in my life is going well. Can therapy fix that? Really?

Obviously I’m venting, but I need to know – how do I overcome this frustration, discouragement, and newly-found skepticism as I try to pursue care from the people who I feel have let me down so badly, and who seem to be tired of dealing with me? I haven’t quite given up on myself yet, but sometimes I think I’m really close to throwing up my hands and calling it quits too. That’s when suicide starts to sound so inviting again, because sometimes I think I would rather die than live like this for another 50+ years. I need a reason to hope.

Thanks.

Thank you for writing. I hope you won’t give in and give up. You obviously are thinking hard about options and trying to take charge of your life. I’m very, very sorry that you seem to have been caught in the gaps of the current health care system. Each doctor was undoubtedly doing what they thought best. But it’s frustrating that there wasn’t more collaboration among them. I’m not surprised if at times you want to throw up your hands in dismay. It may be a small comfort to know that many people with a bipolar diagnosis try for years before they get the right providers and the right strategy to manage their illness.

The good news is that it can be managed. Yes, talk therapy helps. I recently attended a reading by David Lovelace who is the author of Scattershot, My Bipolar Family. He also has bipolar illness. He joked that his mechanic takes longer to change the oil in his car than his psychiatrist takes to review and prescribe his meds. Psychiatrists often have to see 3 or 4 people an hour; not exactly a pace where they can dig in and understand what is going on with someone. That’s why the talk therapy piece is so important as a long-term strategy. Your therapist can help you understand your illness better and learn strategies for coping with it and even using its positive aspects. Ideally, there should be a partnership and good communication between your psychiatrist and your therapist and you. Learning how to live with bipolar illness is a process of self-discovery; not just a matter of popping the right pills.

I think you might find it helpful – even inspiring – to read the books by Kay Redfield Jamison and the previously mentioned book by David Lovelace. You are indeed in very good company. Many people with a diagnosis of bipolar are extremely bright, creative, and productive people. Once they learn how to live with the illness, they become their best versions of themselves.

I wish you well.
Dr. Marie

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