PsychSense: Sensible Psychological Solutions

Question and Answer Post

From a Reader named “Mary”

Please help me! I have been in a relationship with my live in boyfriend about 3 yrs. He is like having another child around. He does not help with things and expects me to take care of everything. He has a bad temper and although he has never hit me when he gets angry he breaks things. I want to end this relationship but when I tell him that he says he can’t live without me and will kill himself if I go. I’m scared! I don’t know what to do. I cry all the time and can’t sleep well at night.

Dr. Duffy’s response.

Mary, this is a tough situation and I can under why you feel scared. First let me tell you that unfortunately this situation is not that uncommon. Men who act like your boyfriend are often very dependent on the women they are with! They try to get what they want and need with threats of all kinds. Threatening to kill himself in order to keep you is emotional blackmail! So what to do…….

First and most important: you must be very sure you want to end this relationship. The worse thing you can do is make threats to leave in hopes that he will change his behavior. When you do this it only teaches him that you do not mean what you say. If these threats do get him to change, it is usually only for a very brief time and then the behavior starts again. So you must so some serious soul searching and make sure this is what you really want. Make sure you are really ready. Once you have done this you must put a plan in place to leave. Try not to do it on the spur of the moment or during a crisis unless you are being physically threatened!

Second: Make a plan: You must decide when you want to leave and where you will go. Many women want the man to leave the home. This is much harder to make happen (although not impossible) and the easier and safer thing to do would be to leave temporarily with the expectation that living arrangements will be settled later. Certainly who leaves the home may be dependent on who ownership. Leaving may also have some legal complications for those who are married and the advice of an attorney should be sought. If there are children involved it is more difficult but that is also all the more reason to go ahead with such a plan.

If you have already discussed your desire to leave you do not need to tell him that you are leaving until you are ready to go. In the process of leaving however YOU CANNOT COUNT ON HIM TO BE REASONABLE. Once the crisis is over and he is certain this is really the end, he may become more reasonable and able to negotiate things. Mediators are available in most areas to help separating people with just this type of issue.

Third: get the help of others. Many women are embarrassed by this type of situation and try to manage it alone. This is a mistake! Secrecy is one of the things that make blackmail effective! You must let people you trust know what is going on. Tell a friend, family members, your boyfriend’s family (he needs support too) and perhaps a professional. You do not need to reveal all the details just make sure they realize you are planning to leave and he is making threats to kill himself. A strategy that often works is to have someone he trusts with him when you actually leave. If you leave and he makes threats you may need to notify the police to check on him.

Fourth: take care of yourself. This is critical. I have a few questions here. Are you depressed? You mention crying and trouble sleeping. Now a certain amount of this is to be expected in this situation, but are you seriously depressed? This is an important distinction to make. Do you have trouble with concentration and memory? Are you anxious and feeling overwhelmed by the situation? Are you feeling hopeless, helpless and immobilized? Are you having trouble machine decisions? Are you eating? Is your energy level where it should be? Do you have a history of depression? These are some questions that might help you decide the level of your depression. Please review the symptoms of depression on the following page to help you decide if you are clinically depressed. If you are significantly depressed you may find it much harder if not impossible to leave while you feel this way. If you think this is the case you should consider having an evaluation by a mental health professional. If you are depressed there are medications and some herbs that may be of help to you. Once you feel better you will be more able to deal with this situation.

The other question I would have in this area is IS THIS A PATTERN FOR YOU? Do you have a history of getting involved in the same type of relationships? Do you seem to attract needy people (men and friends.)? Do you try and take care of everyone. Do you take care of yourself? Do you feel good about yourself? These are important questions to answer for your own emotional well being and to help with future choices.

You must remember no one is responsible for the life of another person. We all must take responsibility for our own lives. Just as you cannot cause someone to take their own life if they wish to live, you also cannot prevent it if they are determined to die. Suicide is not usually the result of a single loss, but the end of a long history of depression , problems and pain. Persons like this are in desperate need of professional help and sometimes staying with them to try and help may actually prevent them from getting the professional help they really need. GOOD LUCK!

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Helping Professionals Especially Women, Must Learn to Take Care of Themselves.

This is much easier to say then do! Although there are more men in the helping professions today, in nursing and social work the vast majority are still women.

Womens’ Sense of self is Often One of Caretaker and Nurturer, and Society Enforces This View.

Nurturing and care taking have long been associated with women in general, and nurses and social workers in particular. Empathy is a mainstay of the helping professions, particularly the “women’s professions” such as nursing and social work. Nurturance has historically been intertwined with, and seen as a major function of nursing. Nursing has been called the “practice of professional nurturing”.

Who Comes First You or Me?

When a woman must choose between caring for herself and caring for another, social pressure fosters the choice of nurturing of others. Women often experiences conflict when faced with what may seem like the continual choice of caring for others or caring for themselves. It is not unusual for women to have difficulty saying no or setting limits, thus ending up doing more than they really want to. Women frequently nurture everyone but themselves and end up feeling conflicted, unappreciated, resentful, and burned out. Women already struggle with these issues, but this is much worse for those in the professional role of nurturer/helper.

Some Important Reminders for Women in the Helping Professions

• Take care of yourself, it will relieve some of your stress and allow you to better take care of others
• Learn and use self-empathy and self-nurturing techniques.
• Try understanding and treating yourself with the same care you give your patients or clients.
• Allow yourself to say no, offer alternatives, or even avoid situations if you feel unable to say no.
• Increase your self-awareness
• Plan for a routine to help ease the transition from work to home. (Do not use alcohol to unwind)
• Do not expect all your feelings of self-esteem to come from your profession or your nurturing.
• Develop outside interests that have nothing to do with helping others!
• Try to avoid over-identification with patients.
• Recognize and allow your own feelings
• Develop relationships outside of work where you can talk about your feelings.
• Practice stress reduction techniques (exercise, relaxation, meditation, distraction)
• Plan for regular breaks, days off, conferences, and vacations.
• Talk with colleagues to not only complain, but also to also make plans for burnout prevention, take charge where you can.
• Know when to say “enough”, consider transfer or another area of work if necessary.

Burnout Can and Must be Prevented.

Recognition of your own level of stress and self-care are the keys to stress reduction and burnout prevention. When self-care is a priority, helping others can be the rewarding successful career it is meant to be.

Ironically, beginning signs of burnout can have an unexpected positive influence in your life; if you don’t let it go too long. These signs can act as a catalyst for you to make a much-needed change. They can be the impetus to move on to different areas of your profession or even more rewarding careers. Caregivers in search of something more have become entrepreneurs (the writer included). They have developed many ways of working as a helper that allow them more reward both financial and personal, and more control over their careers and their lives.

Take Care of Yourself!

Vincent Van Gogh, believed to have Bipolar I Disorder

Questions by Readers.

Dear Dr Duffy,

I am confused about my daughters illness. She is in a residential treatment facility and we have had a terrible time trying to control her. She has been given a number of different diagnoses including Oppositional Defiant Disorder, Schizophrenia and Bipolar disorder. My question is, is Bipolar and Schizophrenia the same. She seem to have many symptoms that could be either. How do the doctors know the difference between these illnesses? She is on many medications and although she is calmer I am still not able to control her at home. I don’t know what to do.

Any insight would be appreciated.

Worried Mother

Dear Worried,

I am sorry for the you and your daughters distress . This is a very difficult situation to deal with.

For the diagnosis of Schizophrenia to be made, certain symptoms must be present, such as hallucinations and/or delusions. These are not necessary for a diagnosis of Bipolar disorder although may be present in severe cases. I do not know how old your daughter is but Bipolar is a controversal diagnosis in children.

There are 2 types of Bipolar disorder, Bipolar I and 2. Bipolar I is the most serious type and may have psychotic features (out of touch with reality) . Bipolar 2 is often more closely related to personality disorders.

Yes, it is possible to have both a Bipolar and Schizophrenia diagnoses. In fact there are some in the field who think they Schizophrenia and Bipolar are just different presentations of the same underlying illness. Usually persons with Schizophrenia who have severe cycles of mood (depression and mania or hypo-mania (less severe)) are diagnosed with Schizoaffective disorder.

Certainly behavioral problems can also be caused by personality disorder, such as oppositional defiant disorder. When this is the case, medications usually have little success.

Psychotic disorders, including both Schizophrenia and Bipolar disorder are  usually helped by antipsychotic medication. (Risperdal, Seroquel, Zyprexa, Geodon, Abilify, Haldol). Often mood stabilizers are necessary with Bipolar I disorder (Lithium, Depakote, Tegretol, Lamictal)

This is a  complicated situation, and you may want to get a second opinion. Make sure the Psychiatrist or Psychiatric NP you see listens to you and explains what they are thinking in terms of diagnosis and treatment.

Remember Psychiatry is not an exact science.

Good Luck,

Dr. Duffy PhD, NPP

Today The World Lost a Caring Man Way Too Soon.

Michael White formalized and introduced the idea of using storytelling as healing in psychotherapy. He introduced the idea of Narrative Therapy to many professionals who needed to be reminded of the power of stories and the importance of helping patients tell their stories in a therapeutic way. Of course people have also been telling their stories to therapists for a long time. The stories of their lives, of their pain and joys and of their healing.

Story telling has a long history.

Stories are used to teach lessons in all Easten and Western religions. In Christianity Jesus used stories to teach, in Buddism Buddha, Lao-Tse in Taoism, Confucius in Confucianism. Native Americans told many beautiful stories as does the Tora in Judasm. There are many more traditions that use stories because stories are powerful !

How We Tell Our Stories

Today we tell our stories in books, articles, blogs, journals and many other avenues. If you haven’t heard about Storycorps check it out, It is fascinating , touching and a learning experience. Why do so many people want to tell their stories? We tell out stories because they affirm our life, leave a legacy and also because telling our stories brings healing to us and others.

How to Tell your Story!

Is it time for you to start to tell your story for yourself, for the next generation, and for for those you wish to share it with who may need to hear it ? Remember you do not have to share this with anyone you don’t want to, this is for your personal well being. As time goes on you may find some things you really want to share.

You don’t have to be a professional writer to tell your story, in fact, you don’t even need to write, you can use one of many ways of recording. Speak just as if you were talking to someone you completely trust. When you start to tell a story it might help to be specific, especially if you have a particular issues to deal with. Your life is a book of many chapters (stories).

It may be easier to start off by asking yourself about how you learned certain lessons in life.

• How I learned to love?
• How did I learn about anger and how to deal with it.
• Where did I learn about how to be in intimate relationships, what did I learn?

Your stories are not fairy tales and will probable bring up sad feelings, unfulfilled dreams, and pain that lingers on. However, in your stories you will also find self understanding, forgiveness of self and others, triumphs, and strength. The real benefit is in understanding how and why you learned to do things that you may want to change today. Recognition is always the first step in letting go.

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