Ask the Therapist Ask our resident Psych Central therapists. 2017-05-24T18:30:08Z Kristina Randle, Ph.D., LCSW <![CDATA[I Think I Have the Capacity to Kill]]> 2017-05-17T16:49:57Z 2017-05-24T18:30:08Z

I have been thinking about my morality a lot lately since watching Death Note. I cant’ help but think about what I’d do if one dropped out of the sky; would I use it or not? For months now I’ve been questioning my morality. I’ve always said that no one should get the death penalty, but I find that I often go back on that without realising. I’ve been watching Dexter recently, (don’t think I’m romanticising his life or anything) and I can’t help but think that if I could get away with it, if a bad person was strapped down helpless on a table in front of me, that I would kill him. As well as that, for a long time I think I’ve been developing mild sadistic tendencies. I’ve never felt like hurting someone in real life but I love seeing characters suffer in their respective universes. I have been thinking about how this happened, and it made me think about a time 3-4 years ago when the ISIS beheading video came out. I was scared to watch it because it was real, but I wanted to see what death looked like. In the end I didn’t watch it, but I did watch the Facebook video of the homeless man being shot. The description on the website warned against watching, saying something along the lines of, ‘it’ll ruin your entire day’, but after I watched it I was just disappointed because of how anti-climactic it was. I know a guy died, but even now I just can’t get myself to care or feel sorry for him or his family, even though i know I should.

I’m worried about my mental health because of this. I think I understand morality but then I contradict it, and no matter what I do I can seriously imagine myself killing a bad person if they were just tied up on a table and I could get away with it. I feel remorse so I know I’m not a sociopath, but when I imagine hitting a kid with a car or watching someone die in front of me, I can’t imagine myself panicking at all. I wen through a dark time a few years ago and even considered killing my mother and sister just to know what it felt like. I don’t know what I think anymore. Please help.

A. You have been thinking about death and morality. You imagine how you would feel if certain events were to take place but the truth is, you don’t know how you would react. Imagination and reality are not the same. You would likely react very differently to witnessing, in-person, the shooting of a homeless man than when viewing it on a computer screen, in the comfort of your own home.

In the case of real life you are physically there, immersed in the situation. It may require you to act. In the latter, it is similar to watching a movie in which you have no role and no connection and thus no action of you is required. That’s probably why you can just as easily watch Dexter as you can a video of a homeless man being shot. Viewed through screens, there is seemingly no meaningful difference.

We have as a culture become desensitized to death and violence. Movies, television shows, video games, and the Internet are filled with gruesome violence. Many people did watch the ISIS beheading video that you mentioned. Without the Internet, very few people would have ever seen that video. These videos and others like it are just a click away.

People have become desensitized to seeing violence in the media. It no longer produces the same types of emotional responses it once did. This desensitization can negatively impact how we treat each other. Studies have shown a correlation between watching violent media and acts of physical aggression. Some studies suggest that people who regularly watch violent media are more likely to be physically violent.

There’s an old adage “you are what you eat.” It means that if you eat well your body is healthy and if you eat poorly your body is unhealthy. The same may be true for media consumption. Perhaps, you are what you watch. The media you consume can take a psychological toll. You might be watching excessive amounts of violence. In some research studies, excessive violent media is defined as more than two hours per day. You should limit the violent content you watch, especially in the context of having thoughts about killing your mother and sister.

Ideally, you should stop watching all violent content. At minimum, you should balance out the violent content with non-violent and uplifting content. Maybe try watching the Netflix series The Kindness Diaries. Another positive source of material can be found on the YouTube channel “Omeleto.” These programs and videos are very different than Dexter.

Finally, you might consider consulting a therapist to explore what attracts you to violent media. These and other issues can be effectively addressed in counseling. Good luck and please take care.

Dr. Kristina Randle

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[I Can’t Seem to Control My Actions Sometimes]]> 2017-05-17T16:30:56Z 2017-05-24T11:30:30Z

I have a problem with doing the wrong thing. I can see myself but I can’t stop myself. I can only describe it as being in the passenger seat of a car, but I’m also driving. I can see myself driving recklessly, I’m screaming at myself to stop but the driver ignores all my pleading. It has ruined jobs, friendships, and worst of all my relationship with the woman I love. I drink heavily and that makes it worse. I’m  working on my alcoholism , but what do I  do about not being able to control of my actions sometimes? (From the USA)

A:  I admire your desire and persistence in trying to deal with these issues. The alcoholism is often tied into problems with anger and impulse control. Rather than see you trying to control your actions as a separate concern, work on the most central issue — your drinking — which will help I you with everything else. I’d begin by going daily to meetings for Alcoholics Anonymous.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

Dr. Marie Hartwell-Walker <![CDATA[Extreme Apathy]]> 2017-05-17T16:29:13Z 2017-05-23T19:01:10Z

From Columbia: I don’t actually know what’s wrong with me, or if there is, but for the past years i have lost interest in everything and I feel like by now nothing makes me sad, upset, angry, excited, happy or anything at all anymore. It seems like I don’t have emotions, but I don’t think i’m depressed.

I have always been an introvert but that never bothered me I have close friends, I have an okay relationship with my mom, I haven’t faced any real loss. But, recently I was told my grandfather, who i have always been really close to, had a terminal illness and I didn’t feel anything at all, my best friend of years left the country and I’ll probably never see her again but I also didn’t feel sad at all. I didn’t feel anything. Another time, I was almost run over by a car, in fact, it did hit me, and even when i was laying on the ground with people staring at me asking me how i was i couldn’t bring myself to feel scared, there was nothing. No feeling.

I’m on my third year of university and whenever people ask me if this is what I want to do, i don’t know what to say because I don’t “want” anything, I don’t have dreams or anything, not even a small goal, I can’t see a future for myself and I can’t imagine myself living for long enough to actually have a job where I need my major. I don’t have suicidal thoughts, but I wouldn’t mind dying, if that makes sense. Sometimes I wish for it.

I tried going to a therapist, but she kept asking me if I had lost something that made me give up on my emotions too but there was nothing, not even a metaphorical death. But, for the most part I think I’m fine and I don’t want to tell anyone because they might think I’m making it up since i’ve always been “happy” and I don’t have any reason to not feel like it. And maybe I’m just making it up and being dramatic, maybe i’m just too calm and get over things too quickly. But I’m also tired of not feeling, i guess.

A: I can’t make a diagnosis on the basis of a letter, of course. But I can tell you that everything you report is consistent with a diagnosis of depression. I don’t know why you think you aren’t depressed. Feeling hopeless, devoid of emotions, and uncaring about life are all characteristics of depression.

I’m sorry you did not connect with the therapist. But all therapists are not alike. You may not have told her your symptoms as well as you did here. She may not have experience with depression that doesn’t seem rooted in a particular event or series of events. Whatever the reason, the two of you didn’t connect. That doesn’t mean that therapy isn’t for you. It does mean that you need to see a different therapist.

I encourage you to make an appointment with another counselor, preferably someone who works with a psychiatrist. If you don’t feel heard, make an appointment with another. It is not at all uncommon for someone like yourself to try out 2, 3, or even 4 counselors before finding one who is comfortable to work with. Take your letter to us with you to show the counselor during the first appointment. It will help the two of your get started.

The reason I suggest seeing someone who collaborates with a psychiatrist is that I think you will probably be encouraged to include some medication in your treatment — at least at first. A counselor cannot prescribe medication. A psychiatrist can. The preferred treatment for depression is often a combination of medication and talk therapy. You probably do need both to get out of this gray mood.

I wish you well.
Dr. Marie

Kristina Randle, Ph.D., LCSW <![CDATA[I Don’t Know What Is Going on Anymore]]> 2017-05-17T16:00:20Z 2017-05-23T15:10:50Z

Honestly, i don’t know how and where even to start… and i dont know how to say all of this in only 400 words…recently ive started to suspect i might have schizophrenia. i believe that everyone is watching me, and i cant trust anyone (that includes you), that there are cameras everywhere, that i am dead and that this is just someone trying to see how id be after my death. ever since i was little too (about 5) i believed i was being watched by people on a secret island and made a film of. i try to convince myself that it’s not real;that there’s no way it’s real..but i cant. i have a psychotherapist, but i just can’t tell her anything i want to. i can’t force myself to tell her anything, but i really want to. and when i tried to explain my anxiety and attacks to her, i couldnt explain it properly.(diagnosed me with DID but i dont feel it at all) at school, when someone asks me something, i can never explain my feelings AT ALL. i always get something wrong,even though i know the answer.i’ve noticed that sometimes my sentences dont make sense to my friends, because i cant even say a sentence properly and i see things they don’t. i also have severe ptsd where at times i go completely deaf and nightmares, but the memories came back only recently (after 3 yrs) and i am sure im just making it up so i can pity myself and have a reason to be depressed. during the past 1yr i also ended up diagnosing myself with different disorders to explain my head-but always changing my mind..(pathological lying,ADD,PTSD,schizo,cotard delusion,SAD..)i know it’s wrong to diagnose myself;but since i cant tell anyone,and just keep lying all the time,im curious&desperate i only have this.i discovered something about myself though-im comfortable anonymous.there’s also always someone watching me from my bedroom window and suicidal(but im dead anyway so).i have crazy voices in my head that i cant control.i can barely tell whats real and whats not.i hate lying to my friends and family all the time about the smallest one knows though.i cant really put all my emotions and things going on in 400 words.but this is without many details…

A. It is important to tell your therapist about how you feel. If you can’t say it face-to-face, then write it in a letter. You wrote us a letter here at Psych Central. You can just as easily write your therapist a letter or give her this one. Your treatment might improve if she knew what was wrong. She may be treating the wrong symptoms because she doesn’t have all of the facts.

You might fear that she’s going to judge you but therapists would not do that. Their job is to help people with whatever is wrong. Therapists want to help and are used to hearing about many types of problems. What you reveal will not be shocking. It will help her to know how to help you. It’s the first and fundamental step in getting better.

You mentioned feeling suicidal. Thoughts of suicide are indicative of immense suffering. This cannot be ignored. I’ve seen many people overcome these types of problems and you can too. But it begins with you revealing the scope of the problem to your therapist. Utilize the help that is available to you. Call the authorities if you are in danger of harming yourself. Please take care.

Dr. Kristina Randle

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[Possibly Unsupportive Parent]]> 2017-05-17T15:56:38Z 2017-05-23T11:25:34Z

For a lot of the time I feel indifferent about everything.  It feels like I’m just floating along through life, not really caring much.  For example, I didn’t really care where I ended up going to college, and I should.  I should care that my best friend is going to be moving several hours away that ‘m going to be graduating in less than a month, and that soon I get to live with my sister, but instead I don’t really feel anything, not sadness or happiness just nothing.  But at the same time, I act the same.  I still crack jokes and laugh.  Life just doesn’t feel like it’s quite real.  Sometimes, I’ll be walking and I’ll feel like I’m shoved back into reality.  I don’t know how else to describe it.  It’s like I’m suddenly reminded that I am not a floating voice, I have feet and a body.  I don’t know how long I’ve felt like this, but it’s probably been at least 2 or 3 years, maybe more.

Also, very recently, when swim season ended and I was no longer swimming everyday, I started to suddenly feel really anxious and guilty about events that happened days, weeks, even years ago, especially when I’m trying to sleep.  It’s usually never about anything that mattered or anything that anybody else even remembers.  I’ll think about how ridiculous I sounded when saying something, or how I could have possibly offended someone (even though I know I probably didn’t), and I can’t get the thoughts to stop.  Sometimes I’ll end up digging my nails into my arm or bite my fingers so hard it will leave marks in the morning.  I started swimming again, and that helped.  And I should probably mention that every once in while this year, and a couple of time before in years past there would be times that I would loathe myself and not find much reason to live.

I know you can’t give me a diagnosis from only two paragraphs, but do you have any ideas?  Also, I don’t really know what to do about this either.  Even if I tell my parents, I don’t know if my father would be supportive, and I can’t afford help on my own.  Worse comes to worse, the college I’m going to has a counseling center, but that will be at least a 4 month wait. (From the US)

A:  Your description sounds like it is an unwelcome set of conditions, but there also may be some clues to what may be underneath it. It is clear you are at a transitional time in your life an you have mentioned at least 6 major changes:

  1. You are graduating and leaving what you know
  2. Your best friend is moving away.
  3. You are about to begin college.
  4. You ended competitive swimming.
  5. You are going to live with your sister.
  6. You are harming yourself with your nails.

Transitions can be very rough on us and any one or two of these would be a lot. You have at least 6. I would let your parents know that you want to go to a physician. He or she will be able to look for physical causes. As an example, the exercise with swimming produces an array of biochemical changes that have been helpful for you. Tell this to the physician and he or she can determine what nurtients, vitamins, medicine, etc., might be helpful in making you feel better.

The point is — don’t wait. I would certainly sign up for counseling when you get to college, but at least get the medical consultation out of the way.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

Dr. Marie Hartwell-Walker <![CDATA[I Want to Understand and Know What’s Going on with Me]]> 2017-05-17T15:59:16Z 2017-05-22T19:00:09Z

Hi – i am from India for years i have been going through issues and i have been having breakdowns and i dont know what wrong with me. its been years since i actually sat and studied i want to fix things.

i have been to a therapist but she never tells me what is wrong with me and she focuses on doing exercises or give advice. someone even said i am making excuses and making a fool out myself.

i am not able to follow the exercises and i want to know whether i am depressed or having anxiety issues or anything else and i want to know the root cause of why am i like this before i proceed to make changes as i feel having an understanding will help me gain control slowly is this right can i actually do that ?????

A: You and your therapist are not in agreement about the best way to help you. She doesn’t want to get bogged down in the whys. You don’t want to follow her advice unless you have a better understanding of the “cause”. For some reason (probably a good one), the argument has become more important to you than getting on with getting better. It may be, for example, that new issues will emerge that are even more worrisome if you are successful with your studies. Talk with your therapist about whether if is safe for you to change.

Do work with your therapist to look at why you are arguing with each other and to come to agreement about how to proceed. As long as the two of you are in an argument (even if it is a polite one), your therapy will not progress.

I wish you well.
Dr. Marie

Kristina Randle, Ph.D., LCSW <![CDATA[Mood Swings Anxiety & Depression with Paranoia Sometimes & Mild Hallucinations]]> 2017-05-17T15:50:29Z 2017-05-22T15:15:01Z

My girlfriend is paranoid about stuff sometimes (eg. Thinking people are looking at her when we’re in public, likes locks on her doors, makes her Facebook private or deactivates when she sleeps) she is pretty socially withdrawn and will sometimes get into moods where she seems emotionally aloof or depressed (she talks to people on the internet often though) but other times gets into moods to do stuff outside she’s weird about what she wears (only wears black and white cause other colors bother her if she wears them) has a distorted sense of what she looks like often hates how she looks, is pretty impulsive and will randomly want to cut her hair and dye it a different color if she’s stressed. She has social anxiety doesn’t really like to be in public, sometimes will be sensitive to light or smell she says she gets mild hallucinations sometimes (hears mumbling sometimes or her name being called, sometimes sees things in objects or sees a shape for a bit) she was diagnosed with generalized anxiety disorder and panic disorder and prescribed antipsychotics which she doesn’t wanna take cause the side effects she also has a benign tumor in her frontal lobe. My friend says she’s been like this since he’s known her. my anxiety is making me think of worst case scenarios

A. I’m not certain of your exact question, so I can only provide a general response to the set of facts you have provided.

You recognize that your anxiety might be clouding your judgment. Your girlfriend was evaluated by a mental health professional and that should be reassuring to you. It’s possible that she has something more severe than the diagnosis she received, but it’s unlikely because she was seen by a professional and we must have at least some confidence in their opinion. However, having said that, getting a second or even a third opinion is very common. But at some point we have to rely on the experts in their field or we have to conclude that we are more of an expert than they are. Often that is just because we don’t like their diagnosis. We may not like it but it doesn’t mean that they are wrong.

Her symptoms are not well controlled perhaps because she is not taking her prescribed medications. That, of course, is worrisome. She should be following her doctor’s orders. You might suggest that she ask her treating professionals about trying a different medication that has fewer side effects. You might also suggest counseling. Counseling is a highly effective treatment for many of the symptoms that you have described.

Generally speaking, you can make suggestions about what your girlfriend should do but whether or not she follows them is her decision. Worrying about it does not help her or you and in fact, only makes you feel worse. Do what you can and recognize that you have very limited power in this situation. You can’t control other people.

You might consider consulting a mental health professional to help you address your own anxiety problems. Anxiety and stress are psychological vacuums that suck the joy out of life. They should not be your emotional norm.

If you would like to right back and ask a more specific question, I will try to provide a more directed answer. Thanks for your question. Please take care.

Dr. Kristina Randle

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[The Person that I Once Relied on for Everything, Is No Longer There]]> 2017-05-17T15:46:04Z 2017-05-22T11:30:46Z

My sister, whom is four years older than me, was once the most important person in my life. She was the one I would go to for advice, someone to vent to, and just someone to not make me feel so helpless. She was in a very serious relationship, until she found out some unpleasant things about him. They broke up. She became cold and distant. We stopped going out and no longer had that close relationship.  I no longer went to her with any of my internal struggles because I felt like she was not in the right mindset to help me. She even seemed lost. She was my everything.  After losing her, I feel like I have nobody. I always struggled with letting people in. She was the one person who I always knew I could open up to.
They broke up almost a year ago, and things have not changed. I am afraid I have lost her forever. I have great friends, but I also have a phobia of getting close to people and letting them in(except my sister). My family is wonderful, but I cannot talk to them about this. I have brought it up to my mother on several occasions, and she believes that she needs time. It’s almost been a year.
A few months ago, I had a breakdown and told her everything that was bothering me, including how distant she has been. She acknowledged her mistakes, apologized, and said she’ll be better. She didn’t change a bit. I feel as though I will never get my sister back. I have no one to talk to about my problems. I keep it all bottled up inside until I have a breakdown, alone.
I am a a crossroads and am feeling really lost. The person who I once thought would help me with everything, is no longer there for me. What do I do? (From the US)

A:  I am sorry to hear about your sister. This may be a time for you to be a support to her rather than looking for her to respond. I would continue to group my relationships with others and invite your sister to connect with you. Rather than look to her, you be the one that just takes her out and helps her feel a bit better for the night. Sometime the best thing we can do is show our love and kindness for others. This can help them get out of a crummy place, while we feel better extending ourselves.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

Dr. Marie Hartwell-Walker <![CDATA[I Don’t Know Who I Am]]> 2017-05-17T15:42:26Z 2017-05-21T19:01:17Z

From a preteen the UK: I really don’t know who I am anymore. I’ve switched through so many interests and beliefs I don’t even know which ones make up me as a person anymore. I’m very paranoid at what I appear like to other people and what they think of me so it almost feels like I’m ‘building’ a personality to ‘experiment’ what other people think of it over and over again. I also struggle with my name and gender identity and I already have BPD, PPD and ASD as well as anxiety.

A: Of course you don’t know who you are yet. You are 12! The teen years are an important period of time for self-discovery.

I don’t know who gave you all those diagnoses but unless it was a professional, please take care about how much credibility you give them. All teenagers have what can look like personality disorders. All teenagers have some level of anxiety about how others see them. All teens go through periods of what can look like depression.

If that weren’t enough, many teens these days aren’t getting enough sleep which makes everything seem much worse — and can create further anxiety and depression.

Please understand that saying all this is not intended to minimize your concerns. But I do want you to know that your “symptoms” seem normal to me. But I only have a short letter to go by. If my reassurance doesn’t reassure you, please do see a licensed therapist who can really get to know you and offer some advice.

I wish you well.
Dr. Marie

Kristina Randle, Ph.D., LCSW <![CDATA[I’m Very Happy But I Really Don’t Care if I Die]]> 2017-05-17T15:46:42Z 2017-05-21T15:15:15Z

hi i think i have nice life*great parents,great grades,loving boyfrind,a lot of friends who really love me,in fact everyone likes me,i go to gym almmot everyday,i eat very healthy,im etichal vegan,never had any problems in life,everything almmost always worked great for me,couldt aks for anything more)but i could not care less if someone told me that i would die tomorrow,its like 50/50 for me,i love my life but still ready to die..also i cant really conect to anyone,i mean i love my boyfred and friends,but he breaks up with me ill be okey(but i really love him,and he means a lot to me)..and i am going to high schoole of nursing(planning to go to med school when i finish) so when we are in hospital i am always giving my best to help every patient and do whatever i can but yet i dont care about them at all,its same with everyone else,im always happy to help but never care..i often thinks that this is normal and i dont need to tell anyone about this,and im being overdramatic and i have that conversation in my haed a lot,not for just for that,for everything else,im just like no one would care about that anyway so i go through everything alone,i thing i dont care about what they have to say why would them care about what i have to say..and i think i had sort of dissorderd eathing in the past,even today i am not sure that i have 100% healthy relationship with food but ist about 97%

A. If you don’t care about whether you live or die, then maybe you are not as happy as you say you are. Happy people want to live. They value life.

You state that you are not planning to end your life, but if it ended you would not care. You might be describing passive suicidal ideation. Passive suicidal ideation is indicative of depression. Depression is a symptom of unhappiness. It suggests that something might be wrong and needs to be changed.

An alternative view is that you are taking your good fortunes in life for granted. If everything has gone well for you and you’ve never experienced loss or suffering, then perhaps you don’t realize your fortune.

I’m reminded of an Abraham Maslow quote about taking life for granted. Abraham Maslow studied psychologically healthy people and wrote about their characteristics. He thought that people would be more satisfied with their lives if they had gratitude for their everyday blessings such as freedom, physical health and economic well-being. He was “…convinced that getting used to our blessings is one of the most important nonevil generators of human evil, tragedy, and suffering. What we take for granted we undervalue…” Sometimes people only appreciate the true value of what they had after it’s gone, when it is too late.

It would be good to explore this problem with a mental health professional. Counseling could help you understand why you feel the way that you do. You also mentioned disordered eating but did not elaborate. Eating disorders are dangerous. Disordered eating is also a sign of discontentment. If something is wrong, then it’s important to correct it so you can have a joyful life. Counseling could help you achieve that goal. Please take care.

Dr. Kristina Randle

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[Dealing with Strict Parents]]> 2017-05-17T15:35:40Z 2017-05-21T11:30:05Z

I am 21 years old and my parents are still super strict with me. I have a job, I go to school, I pay for my own schooling, pay for my own expences( car, phone, insurance etc.). At home I do all that needs to be done, including taking care of my little sister. I believe that I am responsible enough to be treated like an adult but I’m not being treated like one. Ever since I got with my boyfriend they have become even more strict. I have to be home at 9,  pm and I can’t spend a weekend with his family. We are doing anything sexual and I have told my parents this. I don’t know what else I can do in order to gain some trust and respect from them. Please advise. (From the US)

A:  It is time to have a discussion with your parents about what you need and explain that you can only continue living with them if there is a change. This isn’t a challenge — it is a fact. You are old enough to vote, drink, drive, and serve in the armed forces. Coming home at 9 isn’t what will help you grow. You’ve proven yourself to be VERY responsible. Let them know that their well-meaning attitude has to change and be willing to negotiate with them about a trial period and evaluation to help them see you are extending your responsibility in good faith.

If they stick with their approach then it is time to make a plan to move out. Check with your school about rooming possibilities, dorms, and other forms of housing. You may need to take a loan, but your freedom is worth it.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

Dr. Marie Hartwell-Walker <![CDATA[I Think I Have a Personality Disorder]]> 2017-05-17T15:29:51Z 2017-05-20T19:00:58Z

From a teen in the U.S.: I think I genuinely have a personality disorder because I’ve been suffering with behavioral peculiarities lately.

Ever since I could walk and talk, I had always been quiet and minded my own business. The presence of other people never excited me. I remember I never spoke to anyone even though I was perfectly capable of speech and I still don’t even now in some instances. At the most, I’ll communicate with signs to get what I need.

But with my friends, I’m completely normal.

Growing up, my parents had always gotten the complain that I lose my concentration easily and daydream way too much. It got so bad to the point where I lost precious things without even realising I had them rather lose them? Now I remember being told to do something by someone very clearly but when I asked them about it, they never even told me to do it!

Another thing is that my mood and emotions/feelings vary a lot. One day, I’ll like and think very highly of a person and the next day I’ll hate their guts and think the worst of them. I’m sure this isn’t normal. Same goes for my relationships with people, none of them are ever stable because I feel different things all the time and I can’t tell them.

I struggle with self-esteem and image as well. I had suicidal thoughts when I was 10 but never gave in to it but I did start self-harming which lasted for 3 years. I stopped when I cut too deep that I had to go to the emergency room. Although, I still have urges to do it to feel something because I always feel like nothing can ever satisfy me and that i’ve a void that I cant fill no matter what. I also cry very easily.

I maintain completely different images of myself with my family and with my friends. My family knows me to be a innocent and shy girl who doesn’t do anything bad or knows any vulgarity whereas I’m WILD with my friends. I also have a problem of over analyzing everything after acting out on impulse. Am I just overthinking or is it for real?

A: I don’t know if you have a personality disorder. Most teens go through periods of thinking and acting in ways similar to what you describe as they work on figuring out who they are. Most teens suffer from doubts about their self-esteem at one time or another.

What concerns me more is that you apparently didn’t get a mental health evaluation and treatment when you cut yourself so deeply. You have presented a very complicated picture of yourself. Your letter also shows me that you think hard about things and that you would do well in the give and take of an honest conversation with a therapist.

I don’t have enough information to give you a responsible response to your question. I encourage you to do for yourself what was not done for you when you were in the emergency room. Make an appointment with a therapist. Bring this letter to your first appointment as it will jumpstart your conversation. You deserve to get your symptoms and your apparent double life sorted out. If you could have figured it out on your own, someone as bright as you are would have done so already.

I wish you well.
Dr. Marie

Kristina Randle, Ph.D., LCSW <![CDATA[Feeling Bad After Doctor Visit]]> 2017-05-17T15:27:33Z 2017-05-20T16:00:24Z

I have severe generalized anxiety and treatment resistant major depressive disorder. I am prescribed medication by my family doctor, whom I see once every two months. During my last prescription renewal, I asked him if there are any other treatments or medications that I haven’t yet tried, and his answer was very confusing. He said, “Psychiatry hasn’t changed. The only treatment I know of that works [for depression] is to have a full life, be active socially, work full time, get plenty of exercise, and get up at 6:30am every day.” I asked him, “How do you do that with anxiety and problems, and chronic trouble sleeping?” He responded, “All at the same time, I guess.”

But the “cure” for depression seems to be impossible to do. In the past, I have tried many, many times to live a “normal” lifestyle – to regularly exercise, socialize, work part time, have hobbies, think positively, etc. I always ended up feeling much worse. More depressed, anxious, stressed, and far worst of all, an intolerable amount of guilt and shame from failing.

I asked him if there is anything more I can do to control my anxiety. He told me that the only thing that works is to do something that shakes me out of it, like travel abroad and work with impoverished people. Because I will see people who live in squalid conditions and don’t even have food and clean water and I will understand that I don’t need to be anxious.

I want to live my life as fully as possible, which means treating, managing, and/or accepting my mood and anxiety disorders. But I don’t understand what my doctor’s point is. In order to be cured of depression I need to live according to his prescribed lifestyle even if I can’t attain and maintain it? In order to be free from my anxiety disorder I need to witness abject poverty so my brain will know that my current worries are unfounded? I feel frustrated, guilty, and hurt because the message seems to be that my mental health issues are a result of a character flaw. If I could just live like undepressed people do and count my blessings I wouldn’t have these disorders.

Can you help me understand what he is saying?

A.  I can’t speak for your family doctor. Only he knows the intended message of the words he chose to speak to you. You have described him as a family doctor. I can assure you that a family doctor is not a psychiatrist. A family doctor may prescribe an antidepressant as a first step in the treatment process. If the antidepressant works, problem cured. However, if the antidepressant does not work the next step should be his referring you to a mental health professional. A psychiatrist is a specialist and a family doctor is a generalist. There are times when a medical condition requires the use of a specialist. A surgeon is a specialist. An internist is a specialist. A cardiac physician is a specialist. A psychiatrist is a specialist.

It does appear from the words that you have written to me that your family doctor may have reached the end of his mental health knowledge base. I have known and know many psychiatrists and I have never known them to recommend to a patient that they leave the country and live among the very poor. I am at least adequately knowledgeable of every major treatment modality used by psychiatrists and I know of none that recommend moving to another country and living among the severely impoverished.

After seeing you, your family doctor may well have treated an underactive gallbladder, a case of acne and leg pain. It would be unfair to ask the family doctor to be an expert on internal medicine, dermatology and the functioning of neurons. It is also unfair to ask him to be an expert on mental health. It would not be unfair to ask a psychiatrist to be an expert on mental health because he or she is, an expert on mental health.

Finally, we come to the debate as to the cause of depression. There is no universal agreement. Is it physical? Is it psychological? Is it sometimes physical and other times psychological? Is it sometimes, a little of both?

If it’s physical then we can do surgery or prescribed medications and stop wasting our time on talk therapy. If it’s not physical then we can do talk therapy and stop wasting our time on drugs. Or maybe, we use drugs for short-term relief while the much longer process of talk therapy actually produces the cure.

No one yet, has answered the above questions though many offer opinions and some behave as if they know the answers to the above questions, conveniently ignoring the fact that scientific research has yet to provide those answers.

Most psychiatrists will either provide their own talk therapy or refer to an outside mental health professional. Of course no one in the world is more qualified to prescribe medication, evaluate medication and adjust medication, than is a psychiatrist. However, they know no more about acne than does a family doctor.

Please let me conclude by saying something that I have said in this forum many times. If your professional, be he a physician, a PhD or a plumber, is not solving your problem then by all means and without hesitation, try another. Good luck my friend.

Dr. Kristina Randle

Daniel J. Tomasulo, PhD, TEP, MFA, MAPP <![CDATA[I Have an Unattractive Personality But I Like My Personality, Which Is Why I Feel Hopeless]]> 2017-05-17T15:22:25Z 2017-05-20T11:30:48Z

I’m 18 and have never had a romantic experience of any sort and never came close to having such an experience either. I know it’s atypical and that destroys me emotionally with the kind of insecurities that it causes me to have.

I think it is in part because of the fact that I am overweight but I’ve lost a lot of weight and have been able to keep it off, so it’s not much of an issue for me anymore. I’m way more confident in my looks now, even though I’d still have to lose a little more weight. I’m optimistic about it. Anyways, I am sure it has a lot to do with who I am as a person. I’m generally nice to anybody, I try to make people laugh and feel good but I’m also very rational and analytical and focus on the negative side of the situation a lot of the time—because that’s what I wanna change, so I feel it’s constructive to point out what’s not working. I have no grace and barely any femininity in general. I don’t dance, I barely flirt, I don’t begin conversations with strangers or, in other words, I don’t even seem available. Not because I wouldn’t want to but because all of the things that incidentally make me seem so I simply hate doing. My two main interests are also rather uncommon: politics and philosophy. I like who I am but I don’t think guys are attracted to that and I’m not entitled to being liked, I know, but it still bothers me. I know they like me in a way, since I get along well to very well with 3 of the guys I’ve ever wanted to be with (There have been only four so far) but they’re never interested in me in any other way. It confuses me because I seem to like people who are similar to me but I guess they’re never similar enough to like people similar to them or maybe there is something else wrong here.

I don’t know how to cope with who I am anymore since I like it but it makes me feel very unwanted. I tried to hear other opinions in hopes I might be wrong but I think all the arguments that came my way were poor and only made me more certain of my position. (From Romania)

A:  I deeply appreciate the angst combined with the desire to make things better. I wouldn’t try to change your personality as much as I would try to find like-minded people with similar interests. My advice? Dive into the things you are interested in. Find the groups and clubs and classes that allow you to be more of who you are. Doing this often allows people to be attracted to one another. We tend to enjoy people who share our interests.

Capitalize on your character strengths — not what you are lacking. I’d encourage you to take the VIA character survey for your age group and strive to use your top strengths. This should allow you to be more authentically you, which is typically very attractive.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

Dr. Marie Hartwell-Walker <![CDATA[Fear of Developing Schizophrenia]]> 2017-05-09T18:42:49Z 2017-05-19T18:50:15Z

From a teen in the U.S.: I’m 19 years old, and I have a great fear of developing schizophrenia. It all started when I watched a video about Marina Joyce and her supposed mental illness, and being the idiot that I am looked up the symptoms and noticed something I sometimes do (thought blocking), but I stopped myself from doing that.

Anyway, I have had this fear since August of last year, and it is crippling me. I don’t think I’m developing it because I still laugh, care about my hygiene, quite organized, do my homework, completely self-aware of myself, and I certainly don’t blow up on people for no reason.

The only problem is is that I don’t know if I am seeing things because I can’t remember if I saw anything – I don’t know if it’s my brain playing tricks on me or if I’m creating a false memory. I’m not experiencing any delusions or paranoia, and I do not hear voices.

One day I’m completely fine, and the next day it’s all I could think about, and I don’t know if I’m going crazy or not.

I’m scared that if I have it that my life will be ruined and I won’t be able to do the things I want to do. I want to be happy and normal again like I was last year, and I wish I hadn’t looked up the symptoms, and I wish I could forget about it and move on.

A:  I really don’t think you have schizophrenia. What you may have is an episode of obsessional thinking. You apparently can’t let go of an idea that is distressing to you. Even when you tell yourself not to think about it, you are thinking about it. Your mind has become trapped in a loop of thinking about it, wishing you weren’t thinking, thinking about how not to think about it, which means you are thinking about it. No wonder you are upset!

You need help finding an exit ramp off the loop. The way out is to see a cognitive behavioral counselor who can give you some practical tools and some support to stop the loop. Really. A few sessions is likely to put an end to it.

I wish you well.
Dr. Marie