In the world of addiction treatment, substance abuse is currently most often understood and defined using a psychomedical model. People must possess a set of characteristics to be diagnosed as an addict, which includes excessive alcohol or substance consumption, increased tolerance of the substance, withdrawal symptoms if he/she does intake the substance, and sometimes serious health issues related to the drug use. However, it’s important to keep in mind that addiction is different than substance abuse. The latter is simply the misuse of a drug and can occur intermittently throughout one’s life. For the former, the individual must display a consistent pattern of abuse over a longer period of time. Additionally, there are many different ways that experts understand and describe addiction. The three most common theories out there are that it’s a moral failing, that it’s a disease, or that it’s a behavioral disorder. Taite and Schartt, in “Ending Addiction for Good” (2013) argue that addiction should be considered a behavioral disorder and that treatment should focus not on whether addiction is present because of a “disease” or because of "genetic predisposition." The pain of addict’s lives, not genetics, is what can be seen as the root of addictive behavior. Likewise, there are usually triggers that have tipped the addict over the edge and that trigger is almost always trauma or profound neglect. The benefit to emphasizing the behavioral model of addiction allows providers and patients to consider a broader range of treatment options. The addict can absolutely change behaviors and return to normal living. Another point that Taite and Schartt make is that the behavioral model of addiction encourages addicts to reflect on the events that happened in his/her life that may have contributed to the addiction. They argue that this in-depth work is necessary for lasting, long-term change. They also make the point that the emphasis on biological components to addiction can actually be a defense against exploring the trauma and deeper pain in one’s life that likely is more of the root cause. The use of drugs, to the point of addiction, is usually the individual’s way of coping with pain. The drug allows the addict to withdraw from reality and avoid his/her core issues. The drug’s effects cover the pain of trauma. When the drug wears off, it must be taken again. This cycle continues to the point of habituated activity in the addict’s life. Take away the drug and the pain of the original trauma comes rising to the surface. This self-defeating, self-sabotaging behavior is what addiction is really about.
The best cure for mental illness
Dr. Jean Twenge and colleagues in the San Diego State University psychology department analyzed mental health records collected between 1938 and 2007 from more than 63,000 young adults. They discovered a dramatic and significant increase in psychological problems, particularly depression. In fact, they concluded that students today feel much more isolated, misunderstood and emotionally sensitive and unstable than in previous decades. Teens today are more likely to be narcissistic, have poor self-control and to endorse general overall dissatisfaction with life. Twenge and her colleagues concluded that consumerism is a major reason for the rise in mental illness. Twenge is quoted as saying “We have become a culture that focuses on material things and less on relationships” (Jethani, 2011). While one might have more questions about all the details of this study, it is certainly worth nothing that the rise in depression coincides with the rise in consumerism along with the individualistic nature of America’s society. Implicit in Twenge’s findings is the importance of relationship. A plethora of research confirms the importance of connectedness. Those who are embedded in communities, even if they suffer mental illness, will have a greater chance of healing and of shouldering their pain with dignity. Psychotherapy offers the opportunity to be known, fully known, and still accepted, which is something the human being seems to crave. It is in the context of deep vulnerability AND acceptance that we humans thrive, find meaning, and live life more fully.
Did Abe Lincoln Suffer from Bipolar?
Did Abe Lincoln Suffer from Bipolar?
No – at least according to award winning author, Doris Kearns Goodwin, in “Team of Rivals: the Political Genius of Abraham Lincoln.” However, it does appear that Lincoln experienced periods of depression and manifested a melancholy temperament. In January of 1841, in particular, Lincoln experienced a vortex of events, resulting in one of the lowest periods of his life. He had just experienced his broken engagement with Mary Todd, the woman who eventually became his wife. Two additional events caused Lincoln great pain – his political life seemed at a stalemate and his best friend moved away. What resulted was a period of Lincoln’s life that historians indicate included suicidal ideation and a marked withdrawal from his social life. Letters from that period even state that friends “had to remove razors from his room.” Interestingly enough, Lincoln sought treatment, consulting not only a Dr. Henry, but also Dr. Daniel Drake, a doctor at the medical college in Cincinnati. Lincoln eventually recovered from this very dark period of his life, in part, by monthly visits to see the best friend that had moved away. Author Goodwin goes on to delineate the difference between melancholy and depression. “To be sure, Lincoln was a melancholy man…this melancholy was stamped on him…it was part of his nature and could no more be shaken off than he could part with his brains.” Goodwin states that Lincoln’s melancholy partially indicated a withdrawal to the solitude of thought. As a child, he retreated from others to read. As an adult, he worked through a problem in private. It is Goodwin’s intimation that others frequently perceived this as evidence of melancholy. Also, the contours of Lincoln’s face, when relaxed, seemed to hint a sorrowful aspect. According to Goodwin’s thinking, there is a difference between depression and melancholy, the latter not having a specific cause. Rather, it is an aspect of temperament, of one’s nature. “Melancholy is a far richer and more complex ailment than simple depression. There is a generous amplitude of possibility, chances for productive behavior…” The melancholy that Lincoln seemed to exude “derived from an acute sensitivity to the pains and injustices he perceived in the world. He was uncommonly tenderhearted.” Goodwin argues that Lincoln possessed a profound capacity for empathy and for compassion, making him predisposed to sorrow but also profoundly capable of understanding his colleagues and the people he served as President. And another thing, Lincoln was “extraordinarily funny.“ “Lincoln himself recognized that humor was an essential aspect of his temperament. He laughed, he explained, so he did not weep.” His stories were intended to “whistle off sadness.” So did Lincoln manifest symptoms of bipolar? No, not as far as the history books seem to intimate. Did he experience a profound sensitivity to the events and people around him? Yes, and Goodwin seems to state it was what made him one of the best presidents our nation has ever known.
Bipolar Disorder - An Interplay of Forces
Those diagnosed with Bipolar Disorder experience an array of various symptoms and can often feel confused about what contributes to the waxing and waning of the disease. Most professionals thinks of the cycling of bipolar disorder as reflecting a complex interplay among genetic vulnerability, biological agents, psychological agents, and stress factors (Miklowitz, 2011). By genetic vulnerability, experts mean to imply that there is an inherited aspect to this disease. If you have family members diagnosed with Bipolar, you’ll likely have the propensity yourself. By biological agents, experts mean that there is actual abnormal functioning of brain circuits involving neurotransmitters, such as dopamine. And then there are psychological agents, meaning the internal psychological underpinnings of your self, how you perceive yourself and the world, and your internal beliefs. Finally, the stress agents that the literature points to involve the environmental factors occurring in one’s surroundings that may add stress. Therefore, we do not need to think of bipolar disorders as either a brain disease or only as a psychological problem. It’s more complicated than that and usually entails various contributory causes.
Pain is our friend
The physician who spent much of his life working with lepers in India was a gentleman by the name of Dr. Brand. He discovered that leprosy destroys the nerve endings in the body, leaving lepers unable to to feel. While this fact might seem like a blessing, it is ultimately a curse, resulting in the loss of limbs and even death. Without pain, lepers are unaware they have been injured. Dr. Brand is quoted as saying, "I thank God for pain, I cannot think of a greater gift I could give my leprosy patients." Symbolically speaking, the avoidance of pain can make us emotional lepers - we become incapable of experiencing the aches, pains, and fears of our existence, as well as the joys, the beauties, and freedoms of our lives. Although no one enjoys feeling pain or fear, these emotions play an important role in our existence. They help us stay alive!
What really counts when it comes to effective therapy
I frequently find myself thoughful about what's effective in psychotherapy. Is it particular things I say in response to my patients? Are there specific modalities that are more effective than others? Being the psychodynamic psychotherapist that I am, I possess a natural inclination toward understanding the deeper layers of the human psyche. Somehow, change and understanding the human being takes so much more than just a manualized approach to specific symptoms. For me, it's more about understanding the heart and soul of each person that walks in my door and treating each with as much dignity as I can muster. Each patient is more than just a list of symptoms. Each patient is more than just their pain. When I read the following article on research done in Sweden, I found myself feeling justified in how I've been trained: http://scottdmiller.com/icce/revolution-in-swedish-mental-health-practice-the-cognitive-behavioral-therapy-monopoly-gives-way/
Is psychotherapy effective?
As a practicing psychologist in Pasadena, I'm occasionally challenged by my patients to discuss the effectiveness of psychotherapy. "Will I get better? they often query. It's an honest and legitimate question - one I find myself pondering frequently. To my patients, they want to know whether the benefits of embarking on the strange journey toward self disclosure, vulnerability, and potential pain will be worth it. And will I be able to help them? Will paying for my services, my training, and my expertise be enough of a catalyst for healing? The answer is complex and multi-faceted. There's the issue of goodness-of-fit. Research shows that upwards of 80% of the effectiveness of psychotherapy has to do with the fit between patient and psychotherapist but how does one measure that? Other variables that influence the outcome of psychotherapy include such things as the level of participation of the patient, the level of motivation, and how accurately the empathy in the psychotherapist. With all this in mind, however, and the longer I'm privileged to do this work, the more I find that individuals who walk into my office really are seeking a deeper experience of authenticity and empathy and many are NOT looking for the quick fix. For a fascinating read on the effectiveness of longer term psychotherapy vs short term, see the following link: http://horan.asu.edu/cpy702readings/seligman/seligman.html
The importance of resilience when addressing Post-Traumatic Stress Disorder
For a pretty thorough discussion on the importance of resilience when dealing with PTSD, go to the following link.
http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Reverse Culture Shock on ABC
I was delighted to see that ABC did a recent online article on "Reverse Culture Shock." Take a peek here:
http://abcnews.go.com/blogs/lifestyle/2010/07/social-networking-a-cure-for-reverse-culture-shock/#comment-1614835
Psychotherapy - Effective or Not?
Before embarking on psychotherapy, most people want to know what to expect and how to go about achieving the best kind of help. A lot of people seek help, and may even go so far as to call a psychologist, but once you starting meeting with someone on a regular basis, what then? Is psychotherapy generally a good idea? The basic answer is a resounding “yes!” On average, approximately 80% of folks who enter treatment will walk away feeling as they have achieved some real change. In this day and age, that percentage is actually pretty good! However, in order to achieve that high percentage, it’s important to keep a couple of things in mind. First, finding a psychologist with whom you feel safe and connected is paramount. In fact, research seems to show that this is one of the MOST important variables for good treatment outcomes. Secondly, be aware of the “15 session blues,” a term I affectionately tell my patients to expect at around the 12th to 15th session. Again, research seems to show that a lot of folks are tempted to stop treatment at this point, and it is usually because difficult emotional things are beginning to surface. But…think about it. Most of the things that prompted you to begin therapy took many years to form. Doesn’t it make sense that it’s going to take some time for all that to unravel?
Bipolar Disorder, a Variant of Depression
One of the trickiest mental illnesses to treat is Bipolar Disorder, specifically because of its biological basis and because those who suffer may initially deny they have it. If you, or someone you love, have recently been diagnosed with Bipolar Disorder, I highly recommend The Bipolar Disorder Survival Guide, Second Edition: What You and Your Family Need to Know by David Jay Miklowitz (Dec 15, 2010). This book offers practical knowledge on the symptoms and treatment of Bipolar Disorder and is a must-read for both the general public and clinicians alike.
De-stigmatizing Depression and its Treatment
Did you know that no one is exempt from the experience of depression? Would it be surprising to know that some well known individuals have suffered from depression? Take, for instance, Bruce Springsteen. Even with his career taking off, in 1982, Springsteen remained haunted by his past, which included growing up with a depressive and self-isolating father. Bruce’s own symptoms of depression surfaced just as he was completing the acoustic album “Nebraska,” recounts the musician’s friend and biographer Dave Marsh. But what was shocking was how severe Springsteen’s depression became, reaching the point of spiraling out of control during a cross-country trip. He was even feeling suicidal. But here’s what’s interesting, he began seeing a psychotherapist. He credits receiving treatment with finally healing his past wounds. At a concert years later, when Springsteen introduced his song “My Father’s House” he recalled what the therapist had told him about those nighttime trips: “He said, ‘What you’re doing is that something bad happened, and you’re going back, thinking that you can make it right again. Something went wrong, and you keep going back to see if you can fix it or somehow make it right.’ And I sat there and I said, ‘That is what I’m doing.’ And he said, ‘Well, you can’t.’ ”
Reverse Culture Shock
Reverse Culture Shock, or "re-entry", is a term associated with the phenomenon of returning to one's own country and culture. Very similar to culture shock, a person entering into their home environment will have to make adjustments to reacquaint themselves with their surroundings. Unlike culture shock, most do not anticipate feeling like a foreigner in their own home. However, it should be expected. If you have made any cultural adjustments while abroad, you will have to readjust once back home.
Experiencing reverse culture shock is extremely common and may include any to all of the following emotions:
- Restlessness, rootlessness
- Reverse homesickness-missing people and places from abroad
- Boredom, insecurity, uncertainty, confusion, frustration
- Need for excessive sleep
- Change in goals or priorities
- Feelings of alienation or withdrawal
- Negativity towards American behavior
- Feelings of resistance toward family and friends
(Taken from the following website: www.globalinksabroad.org)
Normal Grief
Normal or common grief begins soon after a loss and symptoms go away over time. During normal grief, the bereaved person moves toward accepting the loss and is able to continue normal day-to-day life even though it is hard to do. Common grief reactions include things like emotional numbness, shock, disbelief, or denial. When this occurs, the individual may feel like they’re not thinking clearly or feel like they’re in a dream-like state. Another reaction usually includes anxiety over being separated from the loved one. The bereaved may wish to bring the person back and become lost in thoughts of the deceased. Additionally, images of death may occur often in the person’s everyday thoughts and it’s not uncommon to feel extremely occupied by the loss. One of the most difficult aspects of loss is the distress that leads to crying; sighing; having dreams, illusions, and hallucinations of the deceased; and looking for places or things that were shared with the deceased. Individuals in grief sometimes feel like they see the person they lost out in public…or may feel like there are constant reminders of the loss no matter where they go. Anger is also a common reaction to loss. Depending on the type of loss, the individual in bereavement may feel their anger is irrational – but it’s not. The person may feel angry at themselves, at the deceased, or at various aspects of the loss. This is common! And finally, there will be periods of sadness, loss of sleep, loss of appetite, extreme tiredness, guilt, and loss of interest in life. Day-to-day living may be affected. In normal grief, symptoms will occur less often and will feel less severe as time passes. Recovery does not happen in a set period of time. For most bereaved people having normal grief, symptoms lessen between 6 months and 2 years after the loss.
Some Things to Expect with Grief
Many bereaved people will have grief bursts or pangs. Grief bursts or pangs are short periods (20-30 minutes) of very intense distress. Sometimes these bursts are caused by reminders of the deceased person. At other times they seem to happen for no reason. It’s important to remember that these bursts of grief are UNPREDICTABLE, which is one of the most difficult aspects for most individuals. Most of us tend to enjoy the fact that we feel in control of our emotions and lives so when things happen that are unpredictable, it can feel very disturbing and difficult to tolerate. However, allowing yourself to endure these distressed episodes, will eventually get us through them.
Treatment for Post-traumatic Stress Disorder
One of the many biological systems that have been identified as being affected by traumatic experiences is the part of the limbic system that is centrally involved in interpreting the emotional significance of experience: the amygdala. The amygdala detects whether incoming sensory information is a threat and forms emotional memories in response to particular sensations such as sounds and images that have become associated with physical threats. These emotional interpretations are thought to be extraordinarily hard to extinguish. Therefore the challenge of psychotherapy is to de-condition the amygdala from interpreting innocuous reminders as a return of the trauma. In other words, certain smells, objects, or relational dynamics have become, for the individual, associated with the actual experience of the trauma, even if the object, smell, or whatever is actually itself benign. Part of what psychotherapy offers as a means of de-conditioning the amygdala is various forms of what psychotherapists call “Exposure Therapy.” Most psychologists can explain what forms “Exposure Therapy” can take.
Treatment for Depression
As common as depression is, it is important to know how to address this mental health issue in the healthiest way possible. Treating depression is usually not a quick fix but if you’re willing to keep at it, you’d be surprised at the results. Treating depression usually includes a combination of elements, and no one element by itself works as well as all of them combined! There are many effective ways to deal with depression, including exercise, talk therapy, medication, natural supplements, and lifestyle changes. Learning about the treatment options will help you decide what measures are most likely to work best for your particular situation and needs. And another fact to keep in mind, research studies indicate that it is usually a combination of both talk therapy AND medication that brings the most effective results. And if you’re like most, the idea of talk therapy can feel intimidating and scary. As understandable as that might be, don’t let it keep you from taking one of the most powerful steps toward change and healing.
Prevalence of PTSD
Just how frequently is PTSD diagnosed? The National Comorbidity Survey Replication (NCS-R), conducted between February 2001 and April 2003, comprised interviews of a nationally representative sample of 9,282 Americans aged 18 years and older. The NCS-R estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%. The lifetime prevalence of PTSD among men was 3.6% and among women was 9.7%. Thus, the diagnosis is by no means uncommon.
Depression in Los Angeles
The Los Angeles County Department of Public Health has issued a new report citing that nearly 14 percent of adults across the country report that in their lifetime they have been diagnosed with a depressive disorder. This figure is an increase of almost 50 percent from the nine percent who reported having a depressive disorder in 1999. Depression is a serious clinical illness that interferes with a person’s ability to function, and it can last for weeks, months or even years. Depression in Los Angeles, like in other areas of the country, places a serious burden on the health and well being of society. One reason for the disturbing rise in incidence may likely reflect a greater awareness about the disorder, rather than any actually increase in the number of individuals who suffer from this mental health illness.
Benefits of Therapy
The research on the effects of therapy continually demonstrates that the relationship between patient and therapist is much more important than the "brand" of therapy, that the personal qualities of the therapist are far more relevant to the success of the treatment than his or her theoretical orientation. There also appears to be temperamental differences among patients that suit them more toward one kind of treatment than another. Analytic, depth therapies tend to be a good fit with people who are curious, who like to figure things out for themselves, who have some tolerance for ambiguity, who are comfortable with emotion, and who have some intuitive sense that there are unconscious processes within the human psyche.
