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Saturday, September 27, 2014

How Do We Know What Is Real?

QUESTION: I believe my husband is bipolar. We have been married for over ten years. He thinks he is just depressed, but he has had major mood swings over the years ranging from very depressed and suicidal to angry rage. He is bothered by life in general,most things are negative as he sees them. He's also very paranoid and thinks of things happening that are unrealistic. when we met he complained a lot, no matter what was happening. These are just some examples, but does this sound like depression, bipolar, or something entirely different?
ANSWER: Sometimes, people have trouble with what we call, "reality testing."  What this means is that some people can not always distinguish between what is real and what may be simply a thought or an assumption.  It sounds like his symptoms of rage, paranoia, and mood swings, are interfering with his life and your life together.  When a person can not distinguish inner thoughts and feelings from the external world, therapy and possibly medications can help reframe a person's understanding of what's real or not real.  I would recommend cognitive behavioral therapy as the technique will help your husband self-assess his internal thoughts and assess their influence on his mood and behavior.  He may need medication too.  There are a variety of medications that may help with his thoughts.  Now the hard part, trying to encourage him to seek counseling!  If he does not think he has a problem, then he will not go for therapy.  It may help you convince him if you take the time to help him assess his thoughts in the moment he verbalizes the thought. For example,  saying something like, "Let's see what evidence might exist to support that thought."  Of course if he has rage issues, please consider your own safety before challenging his thoughts.  There is also the philosophical debate about what is real.  Reality in Buddhism is called Dharma. Buddha says, "We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world."  This means that our thinking pattern determines the ways in which we view all things that happen.  So one could argue that an individual's perception is reality, no matter how skewed others think it appears.  So your husband has a choice to continue thinking his negative thoughts, thus creating his "reality of paranoia and rage," or he can learn new ways of thinking that may, in turn, improve his mood and behavior. There may be several different diagnoses that would fit with his symptoms. Try your best to get him to see a mental health clinician. 

Wednesday, August 27, 2014

Why Am I Sad?

Question: Do I deserve to be sad? Do I deserve to cry? I mean, there are a lot of people out there who have worse problems, worse situations than I do...

Answer:  Many clients often come into therapy asking this same question. The concept of happiness is widely misunderstood. And, the idea of accepting that sadness and crying may be a normal phenomenon is also an area of human feelings that often leads to guilt.  You have guilt that you are sad despite all the good you have in your life.  We suffer because we have so much to experience. We can live deeply in thought and feelings and because of this, we can suffer greatly.  We can not always understand the suffering and this frustrates us.  But, we can decide how we want to respond to the suffering.  You must tell yourself it is ok to be sad, it is ok to cry.  It's normal. When sadness is not normal is when it takes over your life and you are no longer able to function in the realms of work and self-care.  When this happens, it is depression, and it must be treated by a professional.  

Aristotle taught us that happiness is an activity, a process and participation in something that brings us fulfillment.  Happiness Aristotle says, is a byproduct of living a life that has purpose and a life that helps and supports others.  Happiness comes from finding your talents and putting those talents to use for the overall benefit of mankind.  So you see, it's not about the material things you have, it's about your life purpose and helping fellow humans. When you find this within yourself, your sadness will lift. 

And always remember, if it is a sadness that consumes you and keeps you from living, then it is a medical issue called depression. And all medical issues need professional intervention. 

Wednesday, January 30, 2013

My Boyfriend and His Daughter...what are they doing?!

Question: I just witnessed my 39 year old boyfriend in bed with his 14 year old daughter. He was completely naked and she was fully clothed. When I asked what was going on, he said that when she heard me come through the house she jumped in bed to act like she was asleep. Is this normal? There are also other instances when she constantly wants to hold his hand, hug, kiss, and sit in his lap... Is this normal as well... I don't want to sound jealous, but I was never like this with my father and we were always distant... I am unsure if this is something that I should say something about.

Answer: Well go with your gut girl! I can tell by how you wrote your question, you think this is quite odd and worrisome. This is way over in the creeper zone. Time to find a new boyfriend. And, if you suspect abuse, it is your duty to report it to department of family and children.

Buddhism as a Therapy and Psychiatric Medications

Question: I believe I am going to be prescribed medication for PTSD and Depression at my next appointment and I am really nervous. If you were to prescribe medication to me for those conditions, what would you choose and why?

Answer: After seeing thousands of clients over the past 18 years, I have developed a prescribing style that targets your symptoms and not your diagnosis.  I am not a big fan of the diagnostic system in psychiatry today, but I realize we need to use it for insurance reimbursement purposes. That being said, what medications I would prescribe for you would depend solely on your most bothersome symptoms. And, sometimes I recomend therapy only. If your PTSD symptoms include nightmares that cause you insomnia and that leads to anxiety and depression, I would want to minimize your nightmares with prazosin. If your main symptom was irritability and anger, I might prescribe you prozac or seroquel. If your main symptoms are anxiety and panic, I might prescribe you zoloft or celexa or lexapro. If your main symptoms are depression and sadness, I might prescribe prozac, or celexa, or lexapro.  With PTSD though, therapy seems to work best. For people with a history of trauma, reducing anxiety may seem scary because our anxiety keeps us alert for possible attack...so with Buddhism and CBT, we can feel safer with mindfulness and virtue. It takes work and it's not as easy as swallowing a pill! To practice virtue in a Buddhist way, with a therapist who believes like I do, you can eventually regulate your actions, words, and thoughts to create benefits rather than harm...benefits for yourself and for others. You got through the trauma, you are still here, and many people love you. You are strong. You have a right to be strong and strength helps you do good things.  So maybe you need medication while you work through therapy...and that's ok.

Thursday, January 24, 2013

Am I a Psychopath?

Question: I am concerned that I might be a psychopath. I'm not a criminal though. At least, I don't steal or commit violent acts. Actually that's not entirely true. I have committed violent acts in the past and I have stolen from corporations but never individuals. I am really more concerned about my apparent lack of emotion. I don't have a normal fear response, and I am unable to make emotional connections with people, including my own family. I have had many people in my life describe me as being soulless, or unfazable. I think I know the difference between right and wrong, and I believe myself to be a moral person, but I will admit that I do not believe that this has anything to do with a concern for other people's feelings. Rather, i think I am just following a set of rules that I have put in place for myself based on my own definitions of integrity and honor. This is where I start to have doubts. From what I have read, true psychopaths have no comprehension or regard for these concepts. Also, I am not a pathological liar. In fact, I am usually honest to a fault. I don't see myself as being manipulative either, but some of my friends tend to disagree with me on that point. I guess what I want to know is: How can I know for sure, and is it something that I should really be concerned about? From what I understand, if I really am a psychopath, there is no treatment for it. Could there be a better explanation for my specific apparent condition?

Answer: Because this is so concerning to you, and you have strong feelings about the kind of person you want to be, I don't think you are a sociopath. Sometimes, when we are little kids, our parents are unable to show us empathy and love and then we don't learn how to relate to other's feelings. I do worry about the past crimes and violence. You may have some character traits of antisocial personality disorder. And, you may have schizoid personality traits as well. Schizoid personality disorder is a pattern of detachment from social relationships including family, appears indifferent, lacks close friends, shows emotional coldness, does not find pleasure in social activities.  So maybe how you grew up and how your parents taught you how to interact and feel has a part in this and maybe you have some schizoid traits. With some therapy, you can learn how to relate more effectively with people. I encourage you to get therapy. And...no more crimes ok!

Does Abilify Cause Sleep Paralysis?

Question: Hello, I'm taking 30 mg of Abilify per day for my anger and 0.5 mg of Sedoxil (Mexazolam) per day so that Abilify doesn't cause me sleep paralysis. I'm taking this medication for many years now and I can't study. Can you suggest other medication for me?

Answer: I don't think the abilify would cause sleep paralysis. If anything, abilify may cause insomnia, or difficulty sleeping and it has actually been prescribed to treat sleep paralysis with good effect. There have been several studies that reported zero patients taking abilify experienced sleep paralysis. Mexazolam is a benzodiazepine and is used to treat anxiety in some countries. You don't say what symptoms are causing you trouble studying. Is it that you can't focus, can't sit still? If that is the case, abilify may be causing the restlessness. There are many medication options and I encourage you to see the professional who is currently prescribing your abilify so that you can explain what's going on for you.

Sometimes It Is Mom's Fault You're Screwed Up!

Question: Hello, i think i might have Dependent personality disorder but I'm not sure. i am 20 years old and I cannot do things such as make my own bed or pour a glass of water for myself. I depend on my mommy and grandma for everything. its not like i don't know how but something is keeping me from doing those things. in my mind i am not lazy. My mind tells me that if i am lying in bed and have to pee and if i don't get up then that's being lazy. My fiance calls me a big baby. My mommy still wakes me up in the morning and has my cereal already made and everything. If there is no cereal i would not even eat. I am very sensitive. Almost anything will make me sad and cry. I know that if i was alone, i will NOT be able to survive on my own. I get scared just thinking about it. If i am in a place with unfamiliar people, i feel as if someone needs to take care of me to make sure that i am safe and alright. i don't know what is wrong please  help.

Answer: Well, I'm assuming you finished school and took all your tests yourself.  I'm assuming you have an intimate relationship with your fiance and your mom is not there helping you kiss you fiance. So you are making choices about what you want your mom to help you with. In other words, you are in control of all of your behavior and you do it all purposefully.  I'm not so sure you have a personality disorder. Dependent Personality disorder is a pervasive and excessive need to be taken care of that leads to clinging behaviors and fear of separation. That could be you...OR...maybe your mom has done you a great disservice by feeding into your every need. You say you would not survive on your own...but we don't know that for sure because you haven't tried to live alone. Is your fiance going to bring you cereal when you get married? How are you able to successfully have a relationship with a man yet not be able to get a bowl of cereal for yourself?  You see...these two things just don't go together in any sensible way.  Your mom needs to stop doing everything for you and then see what happens. I'm pretty sure when you get good and hungry...your survival instincts will kick in and you'll get some cereal!