PsychSense: Sensible Psychological Solutions

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One of the problems in psychiatry today from my perspective is the use of “buzz phrases” that are stated as facts. A good example is “Chemical Imbalance.” There is the joke referring to the overuse of this phrase about a kid who hits his sister, when his mother asks why, he shrugs his shoulders and says “my serotonin made me do it”. Chemical imbalance is a “buzz phrase” frequently used by patients and professionals alike to refer to one theory of the cause of mental illness. This theory states that an excess or depletion of certain neurochemicals (chemicals in the brain) is at least in part responsible for a variety of mental disorders.

Neurotransmitters do exactly what their name implies; they transmit information between brain cells. If neurotransmitters are decreased, information and activity in the brain is believed to slow down. This is thought to be one of the causes of depression. If neurotransmitters are excessive, information overload may occur. This overload is thought to be what occurs in schizophrenia. However the phrase chemical imbalance is most often used to describe depression in a way that implies fact, and ignores any other factors underlying the depression. In any individual, it is impossible to say this for sure. Chemical imbalance is only one theory of depression, and is generally considered to be only one factor of many thought to effect mood. The term chemical imbalance is used to explain the use of medication for treatment. We do know that medication can be a lifesaver for some and for others may not be of much help.

The neurochemicals of most interest in mental illness are serotonin, dopamine, and norepinephrine.

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Report from Africa.

I apologize for the delay in posting on my blog. Not only is it a hassle getting to an internet café, but the connection is very slow and the last two times I tried the computer went down in the middle of my session. Frustrating!

Anyway, Kenya continues to be a contradiction for me. One minute I am frustrated with the indirect avoidant style of many and the prevalence of corruption. The next minute I am in love with the children, the people, the animals and the atmosphere. It is hard to explain the atmosphere! In the city of Malindi the noise, traffic, trash and chaos is stimulation and exciting for a very few minutes. Quickly I want to run. Compare this with what you find a short distance away: mostly quiet, villages with mud huts, dirt roads with goats and cows roaming them. One minute I am furious and sad about poor treatment of a child, and the next minute one is running up to me smiling and calling my name. They love to tease me yelling “wash your hands!!!!! ”in a husky voice reflecting my mantra and laryngitis since arrival My feelings are a lot like the weather in Florida, if you don’t like it, just wait a moment and it will change.

Here are some pictures of the mud huts and the children washing hands, a practice I am trying to instill. The girl cutting the cake is a smart, funny, extremely caring person that I will sponser for college.

She wants to be an administrator at an orphanage. For about $1000/ year you can educate a child. Remember “educate a woman and you educate a nation”. Thats me and a staff member with her. She made me a thank you cake. Talk to you as soon as I can.

Question and Answer

Anne Writes

I am worried about my brother, he is depressed and refuses to consider going for counseling or medical care.  What Can I do to help him?

Answer from Dr. Duffy:

It is very difficult to help someone who refuses help. First I suggest you encourage him to tell you what his objections are to getting help. Perhaps talking to you will help him clarify and overcome his fears or objections. If you have not already done so you may wish to give him information on depression as a real medical illness, not a weakness of character.  The Mayo Clinic website is a reliable, good source of such information. Perhaps it would be better to encourage a friend of his to discuss the situation with your brother and tell him what he is seeing. Often family members are not the best ones to convince another member.

If he still refuses or won’t talk about it, I suggest trying a little guilt. For instance, the effect of his depression on those he loves who love him. If he won’t get help for his own sake perhaps he would do it for those he loves.

If he still refusing dispite your efforts you need to set limits. This means not always  being available to help him or to listen to him.  Sometimes a type of tough love is called for in situations like this. You need to take care of yourself, and let him know that although you love him, this is what you must do for your own sake.

If you think he is suicidal you may need to call the police to have him forced to have a psychiatric evaluation. I know this will be difficult to do and he may be angry. However this may save his life.

My last suggestion is to give him information on fish oil. Some studies show this to be just as effective in treating depression as antidepressants. Many people are less resistant to taking  3-4000 mg of fish oil a day

Sorry I couldn’t figure out how to deleate duplicate photos.

First hello to all and thanks to the many who donated to help me help African children. I raised over $1500.00 which enabled me to have $500 for  3 children’s programs and buy a few toys to go along with the suitcase full I brought from USA. I have already spent almost 500 on food and medicine for Children of the rising sun.  I am sorry I am unable to thank each of you personally. The kids thank you.

I am also sorry this took so long to get out but the complications and my learning curve were tough, but I am getting it. We move slower here due to the heat, although it is not as bad as I expected.

I arrived safely in Africa after a rather long 30 hour trip. I did manage to sleep a lot which helped pass the time. I spent 2 days in Nairobi which is a modern city with slums very close to extremely expensive homes. I managed to get in some wildlife viewing and met a Masi who gave us a tour and some great talk. He was so very bright and aware of the current situations in the world. I saw giraffes, black rinos, buffalo (not bison), huge flocks of wonderful flamingos with hyenas chasing them. This caused them to all take to flight in a fabulous show of movement and sound.  I of course took some Barak Obama stickers as he is viewed as a national hero here regardless of political view. This made me an instant hit with the people.

I arrived at the home for orphans Children of the Rising Sun after a long 8 hour bus ride that I managed to sleep through despite a bumpy road. The children were naturally very  interested to know if I brought them something and to check me out. Some were outgoing and friendly others shy, some looked scared or angry, it is hard to know what they were feeling but they sure didn’t ignore me!

I am doing some tutoring, many of these kids are so determined to succeed and will be taking difficult national exams soon.

I am playing with the kids a lot, eating lots of beans, rice and Ugali a staple that is made from maize and looks like bread dough. You use it like rice and cover it with whatever you have.

It is hard to put into words how the children from the orphanage have moved me so much already and it has only been one week since I arrived. They have a lot to teach us and I think I will try to capture what I have already learned or relearned from them.

• Helping one another and forming relationship bonds makes you stronger and safer.
  
• Happiness is not a matter of what you own or who you are.
  
• It’s the small things that make you happy.¦lt;br />  
• A personal favorite of mine: food (especially sweets) are not the focus of life.

Above you will find a picture of my Masi friend David, and the children playing with new soccer balls I (you) bought them.

You will also see a group photo of the children of the rising sun.

More to come,

Please send good vibs.

I have been sooo busy getting ready for my trip. I still feel like I have a hundred things to do. I will get them done and next Thursday will be steeling myself for a 16+ hours in a plane and I don’t know how many waiting in airports. Well maybe I can blog while I am waiting.

It is amazing how many people react so positively when I tell them what I am doing. Well maybe not so amazing. Many people feel it is so important to reach out and help others even (or perhaps more so) at times like these when things are tough for so  many. Many of the people who I talk to are trying their best to keep their head above water and still have time to help others. Somehow it makes you feel so good and takes your mind off whatever is worring you.

I have been trying to get permission to teach volunteers in Africa about how to do HIV testing and counseling. I may also teach disaster preparedness.

In terms of the Children of the Rising Sun Orphanage, I have found out that they have 1000 students that come to the school that is part of the complex. My mind boggles at that number, I can see myself with all those kids…. Oh well one step at a time.

I have been trying to buy small (really small) toys at garage sales and a great rummage sale I hit today. When communicating with the staff at the orphanages and outreach it becomes clear they need the money for food, clothing and medicine, thus my hunt for small toys. I must say I think my suitcases are going to be full. Although to be honest I am not packed.

I want to thank all my friends, coworkers and fellow members of Asbury First United Methodist Church, and Braddock Bay Bird Observatory for generous donations. Because of them I have $1500.00 to give to the orphanages.

Well I’m off to attend to my to do list. I will be blogging once a week from Africa but will try to get another post up before I go.

Question From A reader

 Dear Dr Duffy,

Where do I begin? First, a little background: I am a 23 year-old female. I have been married for 4 years to a man that is 20 years older than I. We have had two children age 3 and a newborn. We plan to have more children. They are a wonderful family.

For several years I have felt frustrated and disappointed with life, although I realize that I am extremely fortunate and very blessed. There is an emptiness inside that seems to echo louder with time and yet I cannot put a finger on what is eating away at me.

 Earlier attempts at communicating with my husband regarding these issues have left me feeling weak, unimportant and angry. He doesn’t seem to hear me in anything that I say, so anymore I don’t say anything other than superficial conversing. While I am constantly surrounded by my immediate family I feel extremely alone.

 I have never been a morning person, however, I sleep in as long as my children will allow me and I dread the new day for the tireless effort that will be required. I love the evenings because the day is finally over and sleep offers one slight reprieve of the emptiness. Even simple tasks seem dreadfully difficult.

 I work at home but I avoid my duties and responsibilities as long as possible. The house is often in disarray and I can’t get my work done. It seems that most things that I start I cannot finish.

 One of the only things that gets me through the day is the thought of alcohol at the end of the day, after the boys are in bed. I can easily drink 20-30 ounces of wine in an evening and be able to function quite well.

My biggest regret is that I am breastfeeding, and while I try to time things in the evening so that he doesn’t nurse until the early morning hours, occasionally he wakes up before then and needs to feed. Each morning I resolve to stop drinking but the strong desire to slip into oblivion at the end of the day is too much to resist, and so the cycle continues.

 I used to create fantasy stories that I would live out in detail in order to escape the reality of this life. In a way I used it to cope with reality, and have always enjoyed the stories. However, since I have married and have children I have little to no time to engage in my fantasy worlds.

 When I do things I enjoy my husband gets angry because I am neglecting my other duties and shoots down the small enjoyment I had, so I am back to simply mulling through life and feeling miserable.

 I don’t feel that I can trust my husband with my inner feelings. I feel myself withdrawing from him. I avoid physical intimacy and have a strong desire (sometimes an uncontrollable urge) to pull back from his advances. Why do I avoid him; what is wrong with me?

•  How can I engage in life with joy and enthusiasm?
•  How can I rekindle my relationship with my husband?
•  How can I stop drinking and find something else to take its place?

 I do not want to live like this… and I pray that the Lord will help me through. If you have any suggestions, I would be very grateful.

 -Alone and desperate

Answer From Dr. Duffy 

Dear Alone,

 There are a number of things about your letter that I would like to respond to.

 First I believe you may be depressed. This could be postpartum depression or may have been present before as some of your comments suggest. Here are some things you said that make me concerned about depression.

• “Emptiness inside”
• “I used to create fantasy stories that I would live out in detail in order to escape the reality of this life”
• “The house is often in disarray and I can’t get my work done.”
• “It seems that most things that I start I cannot finish”
• “…sleep in as long as my children will allow me”
• “I dread the new day for the tireless effort that will be required”
• “I love the evenings because the day is finally over and sleep offers one slight reprieve of the emptiness.”
• “Even simple tasks seem dreadfully difficult.”

 Of course I cannot make this diagnosis over the internet, I encourage you to be evaluated by a mental health professional. You may need an antidepressant but it will not help much if you continue with the alcohol.

  Second: Your relationship with your husband. Although you start off saying what a wonderful family you have, you quickly talk about how unsatisfying your marriage is. It is certainly not the situation where you should have more children.

 My suggestion is that you tell your husband that you are very unhappy and the situation must be taken seriously or it most likely will get worse. Be honest about your feelings and worries. Couple therapy may be necessary. If he refuses to go you need to find a professional to talk to for yourself. This will help you to figure out what to do next and help you to answer your final questions.

 Third: Your alcohol intake. It sounds like you have a serious problem because you cannot stop despite multiple attempts and worries about breastfeeding. Many experts feel 2 drinks will not hurt the infant but anything over that may. (you are way over this limit!)

 The other issue is alcohol makes depression worse!  It is hard to know what comes first the alcohol or the depression. My suggestion would be to get some help to stop drinking first. This can be done through many programs and AA. You must do this and it sounds as if you cannot do it alone.

 Please get some help, for your own sake and for the sake of your children, and your marriage. I am truly concerned about you, and send you my best.

Why is Global Volunteering Important ?

When some one learned of my upcoming trip to Africa they asked me why I thought it was important to travel to other parts of the world to help others when there is such a great need at home. I had been thinking about this myself and here are some of those thoughts.

1.  To help us to recognize and decrease our own ethnocentricities and prejudices
2. To learn from others about things we have no idea we don’t know.
3. To foster acceptance and open our hearts to those we view as “different” from ourselves.
4. To make small footprints on the road to world peace.
5. To add perspective to our own worries and “needs”.
6. To appreciate all we have, and to share it with those who have the least.
7. To let the world know that the people of the United States are good people, caring and compassionate.
8.  To learn to view God and the spirit in a more global way.

Hi All,

I am getting more excited as each day goes by. I have soooo much to do. Just figuring out what electronics I need and how to work them is an experience. I bought a Kindle ebook reader and haven’t opened up the box yet.  I had a friend set up my ipod, ( I know some of you techies are laughing at me) and am still struggling with all the features on my new phone. Whew, I never new I would give in to all this tech stuff and be so cool!!!

Anyway, I want to keep in touch with you  while I am gone, but it will be more difficult then usual. The places I am staying have no internet access (one has no electricity!) so to blog I will need to go into the nearest town (Malinda or Kericho) depending where I am. They are about half hour away by matatu (taxi). Here are some more pictures. The first one is the Children of the Rising Sun Home, the second is the town of Kericho.

 Recently a teenage boy who jumped out of a dorm window while drunk left a local college campus and community deeply shaken. He will probably be paralyzed for the rest of his life.  After hearing about this I read a distressing study about teenage self-destructive behavior. The Child and Adolescent Self harm Study From Europe (Brunel University September 4, 2008) reveals more disturbing data about teenagers and cutting.

1.    One out of four cases is not reported and 25% had not told anyone else. How many do we not know about?

2.    Alcohol is a factor in one out of five cases, drugs in one out of eight cases.

3.    Six in ten self-harmers talk of suicide.

4.    Thoughts of self-harm are said to occur in 6 out of every 10 teenage girls and 1 in 10 boys.

5.    59% of these teenagers said they wanted to die.

How To Help

 Recognize those at risk

1.    Those with family history of suicide or self injury or risky behaviors

2.    Those who have been sexually, physically or emotionally abused.

3.   Those who are self critical, with low self esteem, depression anxiety, substance abuse problems and  eating disorders.

 4.    Teenagers who are impulsive with few problem-solving skills are at higher risk.  

 Prevention Involves Teachers, Families, Friends And Other Social Supports

1.  Teach coping skills in school and at home
2.  Encourage healthy social networks.
3.  Educate teenagers and adults about the problem.
4.  Promote programs to help teenagers develop healthy friendships and decrease secrecy.
5. Do not expect more from teenagers then they can do. Remember they are not always sufficiently mature enough to make high level decisions that require recognition of long term consequences.

 References:

Mayo Clinic Website: Self-injury

 Science Daily: September 7, 2008

Did you know that nearly 5,000 teenagers commit suicide each year and that suicide is the third leading cause of death among those aged 15-24 ?

There has been a number of teenagers suicides in the news lately that have been connected to bullying. Many of use are worried and frustrated about the rising problems in schools with bullying and teasing. The connection between bullying and teen depression and  suicide is becoming clearer.  It has been shown that teen suicide is often related to depression that can be worsened by rejection,  isolation,  being bullied, and not fitting in. 

I found what I think is a great video about a program to reduce bullying, teasing and foster acceptance in schools. It is a program worth looking at if your childs school is not addressing this issue in a serious ongoing, manner.  

Take a look!

Of course we can’t expect the schools to do it all. Here are some things that parents can do.

• Keep your children out of your marriage problems.  Certainly you need to talk to your teenager about what is going on because they are well aware of it already. Sometimes their imagination is worse then the reality so be honest with them .  Do not subject them to your fights and arguments or ask them to take sides. Try to remember that no matter how angry you are at your spouse, you both want whats best for your children.
• Acceptance of your teenager (not necessarily his/her behavior) is critical. Yes I love you and always will BUT I do not love that behavior and won’t allow it.
• Reassure him/ her that you love him no matter what.  Remind him that no matter how bad things seem you want to help and problems can be solved.
•  Listen to what they say, you don’t have to agree just acknowledge you heard and try to explain (briefly) why you disagree. No long debates.
• Even if you say it a hundred times, it helps to say ” I love you and will not let you do anything I believe will end up hurting you.”
• Ask him/ her to talk about her feelings. Listen carefully. Model this by talking about your own feelings ( I am frightened for you when I see you doing risky things)  (see my blog on listening)
• Do not make light of  problems ( relationships, thinking no one likes them etc.)  Avoid terms like “puppy love”, break up of relationships can be Very traumatic for kids and often is a precipitant to suicide.
• Do not give glib answers or get angry.
• If you are worried about your child, don’t be afraid to say the word “suicide.” Using the word will not “give him/her ideas” but will provide relief by saying its ok to talk about this.
  
• Remove guns from your home.
• Seek professional help. Finding a good therapist is difficult. Ask around, school counselors may be a good source of referrals but usually can not handle this problem on their own.
• Get help yourself to deal with this. Do not be ashamed of this problem, it is not uncommon enough.