FAQ of Life

Or, EVERYTHING YOU ALWAYS
WANTED TO KNOW ABOUT
MENTAL HEALTH & DISORDERS

Last updated: 14 Dec 2002

Table of Contents

______________________________

This FAQ (Frequently Asked Questions file) will answer your common questions on topics that I often receive in email. I figured if I wrote this once, I would save myself from having to write the same things over and over again, trying to find new ways of essentially saying the same things! If, after having read this whole thing, you still don't have an answer to your question, well then, go ahead and write... We are only on this planet for a very short time (in my book anyway) and I want to help out in any way that I can while I'm here.

______________________________

 

WHERE DO I FIND MORE INFORMATION ON ANTISOCIAL or BORDERLINE PERSONALITY DISORDER? OR ANY MENTAL DISORDER?

If you're looking for additional information on any particular disorder online, you're probably looking in the wrong place first. Online is great for ease of use and fast, instantaneous results. It's a wonderful place for support groups and meeting lots of people with similar problems throughout the world. But it's a lousy place for detailed, objective, and well-written information.

But, if you're going to do it, then here are some of my personal tips for making your searching a bit easier and quicker. Be forewarned, however... In-depth information on any disorder's causes and treatment is not to be found online! Your best bet, first and always, is still either a large retail bookstore, or a large university library. Smaller libraries and public libraries also may have the information you seek and the reference librarian at any library will be more than happy to help you in your search (that's their job!). I know it's more work on your part and all, but it's the truth of the current state of affairs on the Net today.

Where to search... In order of relevance... (While I would put my personal Web page here at the top, it seems you likely already found it if you're here, so I'll skip that one!)

  • Psych Central - Well, gee, I hope you've looked at my own library of resources online in mental health and psychology. While mainly full of consumer-oriented stuff, it has a growing professional area as well.

  • Google - A powerful search engine that uses a proprietary algorthm to help determine whether what you're looking for is relevant to what it finds. It's smarter than any other search engine out there and easier to use than most. (Search Engine)

  • Open Directory Project - The mother of all subject guides. Look in their mental health section for some good links. (Subject Guide)

  • Internet Mental Health - An excellent informational site to research a particular disorder, but their treatment recommendations are often just out-and-out biased toward medication and psychiatry (no surprise, really, given that it's maintained by a psychiatrist). More professionally-oriented than consumer-oriented. (Informational site)

They key to utilizing the full potential of any search engine is reading its help file. I hear a great deal of complaints from people who type in the word "depression" and are overwhelmed by the 200,000 results returned. That's because "depression" is too general a term. Try something more specific such as "treatment and depression" or "psychotherapy and depression." Each search engine also supports various forms of operators; learn to use those operators for the search engine you use most (by reading through their help section). It will save you lots of time in the future!

If you looked in all of these places, guess what? It's probably not online and the time you wasted looking for it all over creation could have been much better spent at the library. (Just kidding...) Well, that's it for this list. This is the list I follow when people ask me this question. No big secrets on it and nothing all that surprising... It just takes a little patience and time and if it's out on the Net, you will eventually find it using this method. And oh, by the way, I don't go in any particular order with the list; it depends on the information you're looking for.



CAN YOU HELP ME? I HAVE A BROTHER/WIFE/HUSBAND WHO RECENTLY HAS BECOME VERY DEPRESSED AND I DON'T KNOW WHAT TO DO!

Nobody can help anyone else better cope with their problems than themselves. As a loved one in a person's life, all you can do is encourage them to seek professional help outside of the family and be completely supportive and unselfish in their time of need. There is no magic thing to say to them so that they will then go get help. They need to make that kind of decision completely on their own.

However, that is not to say that if you went and called around in your local community looking for help for that person, and then left a list of names and telephone numbers of therapists who would see him or her, for that person where they might find it that they might not make use of such a list. Sometimes just picking up the phone and "admitting" a person needs help is the hardest thing in the world to do. While you risk being seen as being too "pushy" perhaps by them (and they might reject the offer of help anyway), I don't think you'd be losing anything by doing this.

If that seems a bit much, or you have a HMO or the like where the person can only see one person (their primary care physician) before being referred on to a mental health professional, you can still help by contacting your local mental health association, if your community has one, and asking for some additional guidance from them. Or, alternatively, some communities sponsor and support a "Helpline" where a free telephone call will put you in touch with a volunteer who can provide you with a local list of mental health resources in your community.

Remember, there is no way to "make" a person get help. All you can do is be supportive and let that person know you are there and care about them. If, however, you are honestly concerned about him or her committing suicide or harming someone else, you should immediately contact your local authorities. Someone who is at risk of suicide or homicide needs immediate treatment and attention.



WILL YOU ADD MY LINK TO YOUR RESOURCE LIBRARY?

Perhaps. But it has to meet the criteria, which are stringent, to assure that the Pointer doesn't become too large and therefore, useless...

  • Your link needs to offer information on a topic that is useful to mental health consumers or professionals. Ideally, it would be on a topic not currently covered in the Pointer.
  • It should be well-organized, easy to load (e.g.- quick), and easy to read. If graphics are used, they should be few and well-placed. Graphics-intensive pages discriminate against those who have slow connections to the Net.
  • Commercial organizations and products generally aren't accepted, unless their pages also provide additional information on an important mental health topic.
  • Pages that are merely "Lists of Links" to other mental health pages also aren't generally accepted, unless their list is unique or contributes to current listings in some way.
  • Web pages that charge for access are not listed.
  • Web pages that are simple advertisements generally are not accepted.
  • Web pages that are incredibly slow to load, for whatever reasons, generally are not accepted, since most people do not want to wait 5 minutes for one page to load.

Links are usually reviewed by me within 1 to 2 weeks. If you do not see your page listed after that time, it's likely because it did not meet one or more of the above requirements.

Add a link here...



WHAT DO YOU GET OUT OF DOING THIS?

Financially, very little (I make enough money from the site to pay for its operational costs and help pay back my student loans). Personally, a lot. I received my doctoral degree from a clinical psychology training program, but I don't currently practice. For me, this is an opportunity to offer my clinical expertise (a little) and knowledge (more than a little) to people, hoping to touch one life, help one person, reach out in some way that might benefit someone with a mental illness. Plus, because of the still-large stigma attached to mental disorders, I feel that the information I provide both here and online in newsgroups and mailing lists might help to reduce that stigma just a little.

If I wanted to be famous, this isn't what I would have chosen. You don't see too much being written anywhere about the powerful work that is done online in support groups and the like, nor do you get very much recognition for your achievements from your colleagues. In fact, while in graduate school, my computer activities were frowned upon and attempts to try and create something more online while there were met with a loud, dull thud. I'm not doing this for fame, but for hope. Hope that others may be helped. Hope that the world, in some tiny, small way, may become a slightly better place to live in. For today. For tomorrow.



DID YOU CREATE ALL THOSE GROUPS YOU LIST?

Heck no! I get a lot of e-mail asking, "Why don't you create a group for Y?" Well, the answer is, "I don't create groups!" (Well, not on a regular basis.) I'm just a catalog service. If a group doesn't exist online for a particular disorder or problem, it is your responsibility to look to create one, not mine. And when you do, I'll be here to include it in my Pointers.

How do I go about creating a new group on a disorder? Glad you asked....



STARTING A NEW ONLINE SUPPORT GROUP

Step-by-step instructions and information about how to go about doing this is available by choosing the above link. It's a bit outdated, and definitely needs updating, but should give you some idea on how to get started.



I WANT TO BECOME A THERAPIST

I seem to get a fair amount of questions about what's the best field to go into if you want to do psychotherapy. Many people are confused about all the various options opened to one who wants to practice. Managed care in the U.S. has only confused the issue further. Here's what I think...

Since 1990, managed care has changed the face of behavioral healthcare significantly. Comfortable private practices for psychologists are largely a thing of the past. Today, most practices are multi-disciplinary and take clients not only on a fee-for-service basis, but often with sliding scales as well. To stay financially afloat, you have to be able to accept insurance and managed care patients, unless you practice in a well-defined specialty area (such as neuropsychology or forensic psychology) which doesn't rely on such payments, or you live in a large city such as New York or Los Angeles where fee-for-service (and psychoanalysis!) is still possible.

Taking these things into consideration, then, it is increasingly common to find managed care companies hiring clinical social workers and master's level psychologists and counselors to do the bulk of psychotherapy work. Unless clear and convincing research proves that using such therapists either significantly harms the patient (highly unlikely) or that using a better-educated clinician results in reduced costs in the long run (also unlikely), a person has little need of a doctorate to practice psychotherapy. Good psychotherapists seem to be born out of experience more so than education anyway.

So unless you have another reason to want to become a psychologist (e.g., to supervise therapists, conduct research into areas of human behavior), becoming one solely to practice seems less and less convincing of an argument. If you do go for a doctoral degree in psychology, there is little benefit or downside to choosing one degree over another (a Psy.D. - Doctorate of Psychology versus a Ph.D. - Doctorate of Philosophy). The exceptions are unless you want to teach or become a faculty member at a university or college and if you want to devote your career to research. For these two choices, you would be best off obtaining a Ph.D. That is not to say that professionals who obtain a Psy.D. degree don't teach or do research (they do). Just that it is easier for Ph.D.'s in the field to get jobs in these areas.

Otherwise, the degree doesn't matter. What will matter is the type of graduate school you attend. It behooves you to spend a great deal of time and attention to finding out as much information about the type of school you are thinking of attending. Some schools churn out excellent researchers but lousy clinicians; others do the opposite. Only a very few do both very well. My own schooling at Nova Southeastern University in Fort Lauderdale, Florida was a mixed experience. While I found that generally the level and degree of education and supervision I received there was excellent, the lack of preparation for a managed-care dominated marketplace and astounding costs of my education disillusioned me greatly.

Which brings me to the last point. Think long and hard before choosing to go to a private university for your graduate schooling. While banks are quick to loan students $10,000 here and $20,000 there, it all has to be paid back, painfully. Starting salaries for clinical social workers can be around $22,000 to $28,000. Starting salaries for unlicensed psychologists is around $28,000 to $38,000. Once you get your license after that first year, the salaries are around $34,000 to $42,000. These are just general numbers and will naturally vary from region to region. But I think they will give you a sense about some of the finances involved. And the importance of not running up too-large of loans while in school; keep them as small as possible.



WHAT DO YOU THINK OF ONLINE PSYCHOTHERAPY?

I believe online psychotherapy has a lot of potential and does a great deal of good in this sometimes all-too-cynical world. Currently, I find the methods of implementation of online therapy (most often done through e-mail) somewhat lacking and devoid of addressing confidentiality issues. But I think the modality itself -- doing therapy online -- is a very useful one and very powerful. I've seen people's lives saved time and time again in mutual self-help support groups. So why can't psychotherapy done with a professional be any less powerful and moving? I see no reason.

But I also think a fair amount of caution is recommended. You need to check out a therapist who offers online therapy services before committing time and money to the experience. Be aware of confidentiality issues, such as the fact that e-mail and most Web sites are not very secure. Make sure you know up-front what you are getting for your money and how long the relationship with your online therapist can last. Is it for one contact only, or do they do ongoing, indefinite contacts? And see what kind of guarantee is in place. If you feel you were ripped off, there should be a way that you can get a complete or partial refund. Complain to your local consumer affairs office and the Better Business Bureau if you feel you have been harmed by your online psychotherapy experience.

So, yes, I think it can be helpful, but just be careful in doing it. We have along way to go in this area before we get to something which approaches existing therapy sessions, where there's two people who can see and hear one another. Doing therapy online often allows a person to express themselves much more openly and honestly in a quicker manner than they could ever do in person. Hence a lot more can be done, potentially, in a lot less time.

I've since written a lot more about e-therapy, a term I coined in 1999 to describe online counseling and the type of unique psychotherapy work done online.



WHAT DO YOU THINK ABOUT "INTERNET ADDICTION DISORDER"?

It's a parody and a joke, created by noted psychiatrist/psychopharmacologist Ivan Goldberg, M.D. I wrote about this at the time it was created, because it was so suddenly being taken seriously by so many people online.

People no more suffer an addiction to the Internet than someone who works all the time suffers from "work addiction disorder," or someone who reads books all the time suffers from "book addiction disorder." The research often cited which purports to "prove" the existence of this disorder does no such thing. The study, by Kimberly Young, Psy.D. of the University of Pittsburgh, was a survey for people who already thought they were addicted. In other words, the population studied was self-selecting. This no more proves the existence of this disorder than if you were to walk into work at 8pm at night and ask whoever was still left from the day, "How many of you feel you spend too much time at work?"

So, no, such a disorder does not exist. Yes, people can express themselves through the enormous amount of time they spend online. And yes, this can create problems for themselves in their real life. However, spending time online can be best viewed as a coping or escape mechanism. It is being used to simply not address those real-world problems which are currently affecting their life. These problems may not be serious and nothing more than just not having a whole lot of real-world friends. Turning online, because it is filled with other people, seems to be a stronger reinforcer than perhaps some other options (e.g., watching T.V.). But it doesn't begin to suggest a full-blown disorder, at least not at the present time in our understanding. Much more research (of the clinically-controlled, scientific type) needs to be done before we can come any closer to truly understanding this phenomenon.

Read more about what I think about Net addiction.



WHAT DO YOU THINK ABOUT MULTIPLE PERSONALITY DISORDER (MPD or DID)?

I seem to see a lot of people online who suffer from (or believe they suffer from) this relatively rare disorder, multiple personality disorder (MPD), now known as dissociative identity disorder (DID). First, MPD/DID is a rare disorder in the general population, as noted. However, many people use the online world to connect with others who also suffer from relatively rare medical or mental health conditions, so the fact that I have come across many people suffering from this problem online is not so significant in and of itself.

The research confirms this is a real disorder. Whether it is being diagnosed more often because clinicians are now more aware of it than ever before, or because people are more comfortable seeking treatment for it remains unknown.

Treatment of this problem is rarely simplistic. Many therapists' goal in treatment is to re-integrate all the personalities into the singular person which exists before them. For many people, this is an attainable goal with a lot of hard work in therapy and a determination and desire to change.

For others, this is not a realistic goal because they have become dependent on and can't imagine life without the other personalities. For these people, management of the existing personalities may be the purpose of treatment. Learning to cope with the blackouts and loss of memory may be helpful, as well as the possibility of integrating lesser personalities into others so a person is left with only a few main personalities over time.

There is no medication used to treat this disorder specifically, although medication may be prescribed to help certain anxiety or depressive symptoms.



WHAT DO YOU THINK ABOUT SUICIDE?

Suicide is a non-answer. It is the perception of a choice, of an action, when in reality, it is about the largest non-action and non-choice one could ever make.

Think about it. Suicide is a symptom of depression. No one ever commits suicide, or thinks about committing suicide in a serious manner without that person being depressed. Happy people don't jump off buildings, tie nooses around their necks, or sit in cars waiting for the carbon monoxide to fill it up. Symptoms of illnesses, of disorders, are treatable and depression is eminently treatable. So a person could end up killing themselves over the equivalent of a cold with a runny nose. Depression is the cold, the runny nose is the suicidal thoughts and feelings.

Okay, so maybe that's being a bit simplistic. But the point is still valid. Suicide is the action of taking one's own life because living is simply too difficult any more. But what is life if not about the trials and tribulations of trying to live? Life for most people is rarely easy. But people who are suffering from depression see life as not only not easy, but impossible. And that's the main difference.

Life is not impossible, but our thinking sometimes makes us believe otherwise. This thinking, as has been shown through decades of research, is flawed. It's called a "cognitive distortion," to believe something which in reality isn't true. We all have cognitive distortions which we live with from day to day. Some are big and some are small. The cognitive distortion which can take away your life is big.

So here it comes down to a choice about whether to believe what you are telling yourself about your life (that to go on would be impossible). Or to believe what the science has shown us, that what you are feeling, experiencing, living, is all a part of the depression. And from a larger perspective, all a part of living.

Naturally, there is no easy answer here for someone seriously contemplating suicide. But if you are at that point, I suggest taking a look at my suicide resources before making any decision which you can't take back. Depression is treatable and I would urge anyone thinking of this course to seek immediate help from a local community helpline or crisis support line or even a hospital E.R. Your life does matter.



WHAT IS THE BEST TREATMENT FOR XYZ DISORDER?

Treatments do not vary all that greatly from disorder to disorder, with the exception of personality disorders. In general and for most people, a combination of appropriate medication and psychotherapy is the treatment of choice for most mental disorders. The exact medication will vary (naturally) according to the disorder, as will the specific psychotherapeutic techniques used.

I often get asked this question and then asked to be more specific. Without knowing a whole lot more about the person who has the disorder, their background and history, etc., it would be impossible for me to say anything more about this. Appropriate psychotherapeutic treatments vary widely based upon the therapist, their therapeutic style, and the personality and style of the patient. So even if I were to say, "Cognitive-behavioral therapy has been shown effective for major depressive disorder," the person asking still wouldn't be much closer to an answer he or she could use than before asking.



WHY IS MY DOCTOR LYING TO ME?

Many doctors today are inadvertently and unintentionally lying to their patients. This is especially true amongst general practitioners, whose knowledge often times comes from articles which only summarize research (rather than reading the research themselves).

The big lie is this -- mental disorders are caused by a chemical imbalance in the brain. All medication does is help "balance" out this anomaly.

The truth is much more complex -- we don't really know yet what causes mental disorders. Some doctors are afraid to say this, though, for fear of looking like less of an expert than they are perceived (or perceive themselves) to be. Research has shown us so far that the relationship between biological and psychosocial factors is a complex and not easily-understood one. To date, no research has shown a causative relationship between chemicals in the brain and the onset of a specific disorder. Until such research exists, saying that mental disorders are caused by this theoretical imbalance is dangerously mis-stating the known facts.

You don't have to take my word for this. The research is available for perusing from any university library. I've done a pretty thorough search in this area, though, and feel that I haven't overlooked anything which could lead a professional, such as a general practitioner, to think we have any of these answers yet.



DOES PSYCHOTHERAPY WORK?

Literally hundreds of clinically-controlled, scientific research studies have been conducted over the past 50 years which prove the efficacy and effectiveness of psychotherapy. Yes, psychotherapy does work.

    Psychotherapy works best within the hands of an experienced therapist.
    Preferably, you would like to obtain a therapist who has been practicing for a number of years and with your specific problem type. You don't want to be any therapist's "guinea pig" for the problem you are suffering (e.g., "Wow, I've never seen someone with dissociative identity disorder before!"). Run away from a therapist who says that and find another, more experienced therapist as soon as possible!

    Psychotherapy works best when it addresses specific, concrete problems in a person's life directly related to the disorder.
    This means that if you are suffering from difficulty concentrating because of your depression, one of psychotherapy's main goals might be to help improve your concentration through the learning of new skills.

    Psychotherapy works best when it is focused and goal-oriented.
    While some people in this world, such as Woody Allen, can afford long-term psychoanalysis which stretches out for years and decades, most of us can't (and it wouldn't do us any more good either!). The most effective psychotherapy is that which sets up a treatment plan during the first or second session which outlines specific and attainable goals for you. The goals should be accompanied by even more specific objectives, which can be easily and readily measurable by either you or your clinician.

    Psychotherapy works best when it is largely time-limited.
    As mentioned above, most effective psychotherapy is that which is time-limited. Most disorders can be relieved within a few months to a year's time. Others may take a little longer. A few years, tops, should be the maximum needed for nearly any psychotherapy to be effective. If you are in psychotherapy for more than a few years, it is probably time to re-examine the needs of yourself from therapy and discuss these concerns with your clinician.

    Group psychotherapy seems to be as effective as individual psychotherapy for many problems.
    A lot of people have an immediate aversion to the idea of sharing their most intimate and serious problems with a group of people. However, for some disorders, group therapy is often the treatment of choice and can demonstrate powerful results in a shorter period of time than if the same person had gone into individual therapy. Group psychotherapy is effective and should be considered a reasonable alternative to individual psychotherapy, whether it be for clinical or financial reasons.



WILL I EVER GET BETTER?

In most cases, the answer to this question is a resounding "Yes!" The vast majority of individuals who seek treatment for their mental disorders will experience relief from their problems within a few months. For some, it may take longer (on the order of a few years even). For fewer yet, treatment may be an ongoing process which occurs throughout their lifetimes, especially during times of increased stress. All of the research to date suggests that for most mental disorders, excluding personality disorders, people will get better if and only if they seek treatment for the problem from a trained and experienced mental health professional. While most people will get better on their own without such treatment, it usually will take 3 to 4 times as long. So instead of a few months of misery, it might be a few years...

This is also why I don't believe that suicide is a very good answer, ever. Suicide is a symptom of depression and once the depression is in remission or is cured (some people don't like that word, "cured"), so are the suicidal thoughts and feelings. They are temporary and simply a symptom of the seriousness of your depression, much like severe chest pain is a symptom of a heart attack.



WHAT DO YOU THINK ABOUT FALSE MEMORY SYNDROME?

Memory is a tricky thing and one which we are only now beginning to understand better. Some research to date has shown that memories can be highly susceptible to suggestion, under the right circumstances. I believe psychotherapy to be one of those circumstances.

So "memory therapy," from my reading of the research, would be a dangerous thing. Any therapy whose sole focus is to recover memories which may or may not have occurred should be avoided. Memories come out on their own, in their own time, for a reason. Otherwise they wouldn't have been repressed in the first case.

So if you remember something which occurred many years ago just recently, that's fine. There's nothing wrong with that and the validity of that spontaneous memory (sometimes associated with a specific stimuli which was present during the original memory) is likely pretty good. You can certainly work with such memories, then, as a part of ongoing therapy which was initiated for other reasons.

But to go into therapy (or hypnotherapy, or any other type of therapy) for the express purpose of trying to figure out whether something happened or didn't happen to you when you were 5 years old is likely a losing proposition for most people. Our memories are not like digital audio tape, which record every second of every event with uncanny precision and accuracy. Rather, they are usually a mix of events which happened in our past and our own perception of those events which have co-mingled over time. To weed out what really happened from what you believe may have happened is a difficult, if not impossible, task.

False memory syndrome may be a real syndrome... or not. In all honesty, it seems too early to tell from the existing research; more is needed before we can say for sure whether this exists or not.



Well, that's it for now. As I get more and more common questions, I will answer them here. I appreciate your support in helping me maintain this resource and letting others know of it. Believe me, I put much of my leisure time and heart into this thing and I hope it is of some value and use to you.

Last reviewed: By John M. Grohol, Psy.D. on 9 Oct 2013
    Published on PsychCentral.com. All rights reserved.

 

 

If you find a path with no obstacles, it probably doesn't lead anywhere interesting.
~ Frank A. Clark