The Trouble with Psychiatrists & Doctors

Until my stint in outpatient treatment, I had my fair share of struggles with psychiatrists. I often felt like they weren’t listening to what I was saying. And out of the 3 that I had seen, the 5 different medications they had prescribed hadn’t worked.

With the initial psychiatrists I had seen, I felt ignored. You walked in for a 15 minute session, perhaps a 30 minute initial session and you talk to them. They ask you how you feel, and you give them some background history on your mental illness. At the end of that 15 minutes, they either up your dose, change your medication or tell you to continue taking it. This often frustrated me, because I would be told to continue taking something that I felt wasn’t working.

I’ll admit that a psychiatrist’s job isn’t easy. There are no tests that they can perform to find out exactly what medication you need to take for your illness. It’s all guess work based on what you tell them; trying to figure out which receptors in your brain are working overtime or are not working at all. But it’s still frustrating trying different types of medications and having them not work or getting viciously sick on them because of the way they are interacting with your body.

My previous therapist had heard so many complaints about psychiatrists and medication that she decided to go back to school to become an APN, or nurse practitioner. She felt that because she saw her clients weekly, it would be easier for her to prescribe a medication that would work for them. I think this is admirable because at the age of 50, she is going back to school and getting her bachelor’s, master’s and doctorate to become a nurse practitioner.

Now that I’ve finally found a medication that works, I feel better. I’m not so down anymore. I’m glad I followed my doctor’s directives at the outpatient center and I’m glad that I’ve found someone who listens to me.

If you don’t feel like your doctor is listening to you or if a treatment plan isn’t working, speak up. Try and explain to them how you feel or, look for another doctor. You’re allowed to see other doctors. Find a fit that works for you and will provide the best treatment so that you can recover. Be proactive, it’s your health that’s at risk.

What’s In A Name?

When you are first diagnosed with a mental illness, it can be very confusing regarding the number of people you are going to meet on your journey to better health. All of these people are here to help you, but what exactly are the psychologists, psychiatrists, and therapists doing to help you? Here is a short guide on the difference between all the medical professionals you will meet when you are diagnosed with a mental illness.

A psychotherapist is an umbrella term for any professional trained to treat people for their emotional issues. A psychotherapist can be a psychologist, social worker, counselor, or psychiatrist.

A psychologist is an expert in the field of psychology which is the “science of the mind or of mental states and process”. Psychologists have to attend graduate school and obtain their doctoral degree, a PhD or PsyD. The difference between a PhD and PsyD, is that PsyD psychologists are trained specifically for clinical work, while PhD often focus on research. Psychologists often have to complete years of internships to gain further training and experience. They also must be licensed by their state boards of psychology. Psychologists are not medical doctors and can not prescribe medication. Psychologists are licensed to do counseling, psychotherapy, and provide treatment for mental disorders.

A psychiatrist is a medical doctor that specializes in the diagnosis and treatment of mental illness via medication. A psychiatrist usually has 4 years of medical school, followed by an internship and residency. They have a M.D. A psychiatrist can write prescriptions for medication. Psychiatrists must be licensed as a medical doctor in their state of residency. They must also pass the American Board of Psychiatry and Neurology’s Psychiatry Certification Examination. Many psychiatrists have a special focus such as major depressive disorder, schizophrenia or bipolar disorder. They will often work together with a psychologist to provide treatment for mental illness.

A therapist is a person trained in psychological methods to help patients. Therapists can be psychoanalysts, marriage counselors, social workers and life coaches among others. A therapist provides support and guidance and helps patients make decisions and clarify feelings to solve problems. Selecting a therapist is a personal experience. You should always feel comfortable and welcomed by your therapist, but also consider their licensing and professional credentials. It may take time to find the right therapist for you, so feel free to shop around for the right fit.

A licensed mental health counselor has at least a master’s degree in psychology or counseling. They are focused solely on providing therapy to individuals, families or couples. The mental health counselor has to have 2 years of additional experience working with a mental health professional after graduate school in order to be licensed. They are qualified to evaluate and treat mental health problems, with much of the emphasis on working with problems of normal living rather than mental illness.

A clinical social worker has at least a master’s degree in social work and very specialized training. Social workers provide case management and hospital discharge planning. They can also act as an advocate for the patients. Some social workers also practice psychotherapy. There are many different types of licensure depending on the state in which they are licensed.

Psychiatric or mental health nurses have specialized training in providing mental health services. They often work with the doctors to form an individualized therapy and medication program for their patients. Some nurses can prescribe and monitor medications depending on the states where they practice.

Here is a quick cheat sheet for clarification:

Psychologist Therapists Psychiatrist
  • Advanced degree in psychology
  • Does research or therapy
  • Diagnose disorders or problems with patients
  • Determine appropriate treatments
  • Work in tandem with psychiatrist
  • Help patients make decisions & clarify feelings
  • Provide support & guidance
  • Includes psychologists, psychiatrists, counselors, life coaches & social workers
  • Any number of degrees or certifications
  • Help patients make decisions & clarify feelings
  • Provide support & guidance
  • Medical degree
  • Does research or therapy
  • Diagnose disorders or problems with patients
  • Determine appropriate treatments
  • Work in tandem with psychologist
  • Prescribes medication
  • Help patients make decisions & clarify feelings
  • Provide support & guidance

 

http://www.webmd.com/mental-health/features/psychology-vs-psychiatry-which-is-better

http://www.webmd.com/mental-health/guide-to-psychiatry-and-counseling

http://education-portal.com/articles/Psychologist_vs_Psychiatrist_Whats_the_Difference.html

http://www.allpsychologyschools.com/psychology-careers/article/differences-therapist-psychologist/

https://www.psychologytoday.com/blog/couch-meets-world/201107/psychiatrist-psychotherapist-whos-who-in-mental-health

 

A Black and White World

Why do we view the world in black and white when there is so much beautiful grey?

This is a question I recently posed to myself. Oftentimes we look at things as good or bad, dangerous or safe, real or fake. Why do we have to put such black and white labels on things? Why can’t something just be; just exist?

There are times when the world can be seen as black and white, but most of the time the world is filled with grey and it’s that grey that we need to embrace. One suggestion is to attempt to rate  something on a 1-10 scale rather than call it good or bad. In this world, we have a need to neatly label something into a box and put it away. We can’t just let things be; there has to be reasoning or justification

I often find myself viewing my world in black and white. In fact, I find myself viewing my world in mostly black. I have a very negative outlook on my life and on things that happen in my life. When I get into a mood, everything becomes bad and I have a very hard time seeing the good or the positive. Even when my friends are pointing out the good in life, I’m knocking it down with something bad.

I don’t know why I view life that way. It’s a hard way to live your life, always being negative, but I don’t seem to know any other way. I need to learn to see the grey in life and maybe I’ll even start seeing the good. My life isn’t all good or all bad, in fact it’s mostly grey but I insist on treating it like it’s black. Hopefully I can one day get rid of this negative cognitive distortion.

Until then I just have to remember that we don’t have to pick sides. Life can be a little good and a little bad.

Rumination

Rumination is the continuous dwelling on issues in our past and difficulties and things that distress us in the present. It is becoming preoccupied with something and not being able to get it out of your mind. There is helpful and unhelpful rumination. The problem comes when you are focusing on what has gone wrong and this leads to negative thinking. Too much negative thinking can lead to depression and maintaining a depressive episode.

Rumination is normal because everyone dwells on their problems to a point. It’s when the circular thinking patterns that are rumination continue in overdrive, that it becomes a problem. Rumination is different than worry in than worry is future focused and often leads to anxiety. Rumination is past focused and leads to depression. Rumination is a learnt strategy for dealing with our problems however unhelpful rumination can lead to inactivity and avoidance of problem-solving.

Unhelpful rumination Helpful rumination
  • Ask my “why…?” questions
  • (Evaluative mode)
  • Why questions tend to focus on the problem, its causes and it consequences
  • “What did I do to deserve this?” & “Will my life ever get better?”
  • Is continuous
  • Asks more “How…?” questions
  • (Process-focused mode)
  • How questions tend to focus on solving problems
  • “How can I make my life better?”
  • Is time-limited. It stops when the problem is solved

One of the biggest strategies for unhelpful rumination is accepting the situation and being mindful in the present moment. Mindfulness is the most useful coping skill for dealing with depression and will be discussed in a future post.

There are many steps to stopping rumination. Some examples would be accepting your situation, being aware that you are ruminating, or distracting yourself. Please follow this link for a list on 11 Steps to Stop Ruminating.

Remember rumination can be helpful if it is time-limited and problem-solving. However, unhelpful rumination can cause and continue depression, so it is better to find ways to stop rumination if you want to continue your road of recovery.

http://jayuhdinger.com/chapters/chapter-3-practice-11-steps-to-stop-ruminating/

http://jayuhdinger.com/chapters/chapter-2-rumination-faulty-thinking/

Trust

I have a hard time trusting people. I’ve watched so many people walk away from me that it’s hard for me to trust that friends are going to stay in my life. I wonder if it’s something wrong with me that makes people walk away. As I’ve been told, there can’t be something wrong with the entire rest of the world, so it has to be me. There has to be something wrong with me. Too bad I can’t figure out what it is.

Maybe my standards are too high. I think that friends should be there for each other no matter what. I’ve answered the phone before at 3 o’clock in the morning because a friend needed me. Why can’t someone do that for me? I think that friends should stand by each other through thick and thin. I only have two friends that I can count on, and even then I’m hesitant to do so. A part of me thinks that if I push too hard, or make too many demands, they’ll walk away and then I’ll be left with no one.

Maybe, a part of me pushes at people because I don’t expect them to stay. It’s almost like I’m pushing them to see where their breaking point is. Because I expect them to leave, I push until they do. Unfortunately, I’m still disappointed and upset when they do. I’m not sure why I push at people. I wish I wouldn’t though. I would like to have more than 2 friends.

I wish I could trust people, but they haven’t given me any reason to believe that I can. In many ‘friendships’ I feel like I have to do all of the work. I’m the one reaching out to them and trying to plan things. That seems to be something that they don’t reciprocate, so what’s the point of trying when they won’t do the same for you? I wish I could believe that my friends wouldn’t walk away from me, but so many have left me that it’s impossible to believe that. I wish I could figure out what the problem is, then maybe I’d have friends.

My Story: Part 7

This is a continuation, part 7, of my daily journal of life after outpatient treatment for depression, and anxiety. Please click for Part 1Part 2Part 3, Part 4, Part 5, and Part 6.

Part 7, Day 1,:

Vacation was amazing!! I lived in the moment and all of my stress and depression melted away. I felt so good on vacation. Of course, the minute I walked through my door at home, everything came crashing down onto my shoulders. So I guess I need to learn how to live like I’m on vacation. That’s easier said than done.

Day 5:

So I’ve decided to get a dog, or more specifically an emotional support animal. I’ve been putting it off lately, but I’ve finally decided that it’s now or never. I can’t keep waiting forever. I’m looking forward to having an emotional support animal. Hopefully it will help me with my depression.

On the flip side, learning to live like I’m on vacation is not an easy task. I’m struggling with it. I was so happy and living in the moment while on vacation and now that I’m home, everything is getting to me. I feel like I’m upset every other day. I wish my depression would get better. Hopefully a dog will help.

Day 12:

Today was a horrible day. I spent most of the day crying. First, I found out that the third dog that I was interested in was no longer available for adoption. Then, I found out that my best friend had changed his plans, making me feel like he had lied to me. Normally, we get lunch or dinner every Thursday, but today I feel like he is blowing me off. I feel like I’m not important or wanted.

All of which is a little ridiculous, because my boyfriend was hanging out with me today so it should have been a good day. At least he lets me use his shoulder to cry on. He even cried a little because I was so upset and he hates seeing me that way. He can be so cute. Of course, I cried when he left. I hate when he leaves. I know I’ll see him again, but I hate that we only get to see each other twice a week. I wish we could be together more.

Day 15:

It’s hard to stay angry at your best friend when he does nice things for you. I’ve been angry at him ever since I felt like he lied to me. But today, he might have found me a puppy and then he stopped by my work on his way home just to say hi. It was very nice of him and I made sure he knew that I appreciated it. It’s just been a struggle with him having a new girlfriend. I feel forgotten until he suddenly decides to do something to show me that I still exist in his life. I just wish those gestures weren’t so few and far between. That can make it difficult to remember.

Day 18:

I got the puppy!!! I was so nervous that my application was going to get turned down. I went and visited them yesterday, but they didn’t have any of the unadopted puppies in so I was told to come back tomorrow. Boy, was I surprised when she asked me if I wanted to take the puppy home with me that day. I wasn’t ready at all!! I had to ask my mom to puppy-sit so I could go get everything I need for her. I’m sure she’ll be a handful but it’ll be so nice having a dog to come home to. I can’t wait to train her!!!

Please stay tuned for Part 8. Here are the links for Part 1Part 2Part 3, Part 4, Part 5, and Part 6.

Accountability & Victimization

Accountability is to take responsibility usually for one’s actions, feelings and beliefs. It is a personal choice to rise above one’s circumstances and demonstrate the ownership necessary for achieving desired results.

Victimization is to become the victim. Victimization occurs naturally when someone is duped, swindled or the necessary enforcements are not followed through. (I.e. victim blaming, etc.) However many people will cast themselves as a victim in order to make themselves feel or look better or to deflect a problem away from them. Victimization is also to deny, ignore, defer, criticize and blame.

Accountable Stance Victim Stance
Sense of reality Excuse Making
Ownership, commitment Projection onto others, Blaming others
Solutions to problems Deflection, Confusion
Determined Action Attitude of helplessness
Implement change Status Quo

People who victimize themselves have stories to explain why things go wrong, while people who hold themselves accountable are empowered by commitment and hard work. These types of victims will ignore their responsibility for a situation, often playing the blame game and creating their own reality where they are always portrayed as the victim. They often feel stuck in life feeling confused, asking for help, claiming that they can’t do something or they will wait to see if a situation will miraculously resolve itself.

There are four steps to moving from victimization to accountability. These can be related back to the Wizard of Oz:

Character Example Action
Lion Courage See It
Tin Man Heart Own It
Scarecrow Wisdom Solve It
Dorothy Means Do It
Wicked Witch Bully (or yourself/mind) Victimization

See It

This first step takes courage and involves acknowledging reality. This can also involve gaining feedback from others to keep yourself on track and gain insight. Accountable people gain other people’s insights and perceptions to add to their own to recognize when you might be acting like the victim

Own It

The second step involves heart and owning your circumstances.Recognize where you are at in life. Are you portraying yourself as the victim? Recognize this and take accountability for your actions and behaviors that have kept you from moving forward.

Solve It

In this step, you must use wisdom to solve the issues. This behavior stems from asking “What else can I do?” It pushes you to find solutions to your problems which leads you to step four.

Do It

This step is the means or way and  means accepting responsibility for your behaviors and actions. you follow through with your plans, implement strategies and execute ideas. Falling short indicates the lack of accountability and responsibility.

According to the Oz Principle, there are 16 traits of accountability. These are:

  1. Obtaining the perspectives of others.
  2. Being open and candid in communication.
  3. Asking for and offering feedback.
  4. Hearing the hard things so that you openly see the reality of the situation.
  5. Being personally invested.
  6. Learning from both successes and failures.
  7. Ensuring that your work is aligned with results.
  8. Acting on the feedback that you receive.
  9. Constantly asking, “What else can I do?”
  10. Collaborating across functional boundaries.
  11. Creatively dealing with obstacles.
  12. Taking the necessary risks.
  13. Doing the things you say you’ll do.
  14. Not blaming others.
  15. Tracking progress with proactive and transparent reporting.
  16. Building an environment of trust.

These steps and traits can be used in your personal and professional life.

https://www.ozprinciple.com/self/steps-to-accountability/

http://www.resourcesinaction.com/articles/PDFs/acctability_vicitm.pdf

Reprogramming Me: My Issues & My Struggles

According to the doctors, I have ingrained personality traits that are causing my depression. This means that I have learned certain ways of thinking and doing things that are actually part of the problem. This basically means that I have to learn how to reprogram my ways of thinking and my outlook on the world. Here are a couple of things they believe I need to work on:

  1. Mindfulness
    1. I’m not very mindful. I’m constantly reviewing the past or worrying about the future, so I have a very hard time being present. I need to learn to stay in the moment and be mindful, to pay attention to what is going on around me and to what I am doing in the moment.
  2. Quick Fix
    1. I want a quick fix to everything. I don’t want to have to struggle for answers or solutions to problems, I just want them fixed immediately.
  3. Catastrophize
    1. This is one of a couple cognitive distortions that I have. I tend to view situations in the worst possible light and look for the worst possible situation to occur. You can read about Cognitive Distortions here.
  4. Avoidance and Fixations
    1. I tend to avoid situations that I don’t want to deal with and fixate on things I shouldn’t.
  5. Negative outlook and worst case scenario
    1. I tend to have a negative outlook on life and believe that the worst possible scenario will occur.
  6. Expectation for things to go my way, or the way I plan.
    1. I have an expectation for things to go the way I plan and for everything to work out exactly as I specify. This is often not the case, and I can get extremely upset when the plans I have made go awry.
  7. Fixation on connection.
    1. Because of a lack of friendships, I have a fixation on connection. I yearn to connect with people and make friends. Oftentimes this connection causes me more harm because I form connections quickly and often believe I have a close friendship with someone who may only consider me as a passing friend.
  8. I also need to explore why group social settings are so uncomfortable
    1. Despite my need for connection, I have a hard time thriving in a group social setting. I need to explore why this is the case. I yearn for connection, but feel uncomfortable in group settings. Why?

I also have issues with my primary support group (my family) which I have discussed here and problems related to social environment which I will be discussing in a later post.

Some of the ways the doctors and therapists have suggested that I work on these issues is by focusing on and accepting myself. I’m holding onto ideals and an old relationship with myself that is only hurting me now. By focusing on myself, something I’m not very good at, I can form a new relationship and connection with myself that will make me a stronger person, and help me fight depression

All of these problems are works in progress and I will continue to update you on my progress in my journey to mental healthiness.

Forgotten

I often feel forgotten; by my friends, family, even acquaintances out in public. It’s almost like I fade into the background of life. Perhaps because of this, I long to be a priority to someone. I long to be important because I rarely feel that way.

As you know, I have my best friend and my boyfriend. They are my two biggest supporters and I rarely feel forgotten when I’m with them. Recently, my best friend just got a girlfriend and while I’m happy for him, I’m desperately scared that I’m going to be forgotten. Based on past personal experience, I’m usually forgotten about when a ‘friend’ finds a new significant other, so because of this I’m afraid I’m going to lose my best friend.

Only having two good friends, I long to make more and am scared of losing the ones that I have. They are very important to me and because of them, I feel stronger in my fight against my depression.

In a world where people just don’t pay attention, I don’t want to be one of those people lost in the crowd. I want to stand out but so often I feel like I just fade into the background, like I’m just another face in the crowd. Feeling like you’ve been forgotten is one of the worst feelings in the world because being forgotten leads to loneliness.

Perhaps this is one of the reasons that I have depression. I have been forgotten and ignored by so many people whom I once called ‘friends’. Maybe someday I won’t be one of the forgotten. Until then, I will continue to do what I can to stand out in a crowd. I will continue to fight against my disease and against the stigma that is attached to mental illness. Hopefully, my voice, my fight, and my non-profit will one day be heard. Maybe then, I will no longer be forgotten.

Cognitive Distortions: Fixes

Now that we know what cognitive distortions are and how this way of automatic thinking affects our moods, we must now find a way to counteract and change these thought processes. Here is a list of the cognitive distortions and steps that you can take to prevent  these types of thinking.

  1. All or nothing thinking
    1. Instead of categorizing things in black and white, try rating them on a scale from 1-10. By rating the situation, you are considering all sides instead of instantly picking a side.
  2. Overgeneralization
    1. Instead of making a judgment and reacting on that, view the evidence. Examine how others are behaving to the situation and why. Is there another perspective?
  3. Mental filter
    1. Am I only noticing the bad stuff? Am I filtering out the positives? What would be more realistic?
  4. Disqualifying the positive
    1. Am I exaggerating my negatives and minimizing the positives? How would someone else see it? What’s the bigger picture? It can also be helpful to minimize social media usage, where we compare our worst to other people’s best.
  5. Jumping to conclusions
    1. Mind reading
      1. Am I assuming I know what others are thinking? What’s the evidence? Those are my own thoughts, not theirs. Is there another, more balanced way of looking at it?
    2. Fortune teller error
      1. Am I thinking that I can predict the future? How likely is it that that might really happen?
  6. Magnification
    1. Thinking that the worst possible thing will definitely happen isn’t helpful right now. Ask yourself, “ what’s most likely to happen?”
  7. Emotional reasoning
    1. Just because it feels bad, doesn’t necessarily mean it is bad. My feelings are just a reaction to my thoughts – and thoughts are just automatic brain reflexes.
  8. Absolute Statements
    1. Am I putting more pressure on myself, setting up expectations of myself that are almost impossible? What would be more realistic? Avoid using words that have no meaning. Please see the list at the end of this article which shows what words are more helpful than others.
  9. Labeling & Mislabeling
    1. Instead of labeling the situation, look at the evidence. Also avoid double standards, these will only make a situation worse.
  10. Personalization
    1. Would most people who really know me say that about me? Is this something that I am totally responsible for? Instead of blaming yourself or another person, consider the circumstances. Look at the situation and view the evidence.
  11. Memories
    1. This is just a reminder of the past. That was then, and this is now. Even though this memory makes me feel upset, it’s not actually happening again right now.

 

Replace… with…
Should Like or Want
Should not Do not Like or Want
Have to Would Like
Must Wish
Must not Wish would not
Deserve Desire
Always Usually/Frequently
Forever Until/Unless
Never Rarely
Awful Disagreeable
Horrible Unfortunate
Terrible Unfavorable
Perfect Successful

http://jayuhdinger.com/chapters/faulty-thinking/

http://getselfhelp.co.uk/docs/FindingAlternativeThoughts.pdf