Tag Archives: depression

Believe that there is more to you

It is a sad and common theme.

A person is struggling: with an addiction, or obsessions and compulsions, or moral injury, or the impact of trauma, and has come to a place where the sense of self has been entirely subsumed by the problem and its pain.

The definition of self becomes “the addiction,” or “the monster who did (whatever has led to moral injury)” or “the mental disorder diagnosis.”

And, of course, as a therapist, I believe it is critical to address mental health troubles with the best of the science we have, with the particular approaches suited, as discerned ongoing, with the specific needs of that client.

But I also believe that a parallel need is extant and urgent: the need for this person, who is suffering, to come back to an awareness of self as a deeply beloved child of God. Not generically loved, like we may say that we “love” some food or activity or type of animal – but particular, personal, and intense.  Women who, like me, have been blessed to give birth will recall that wild wave of emotion that engulfs us when we meet that little person face-to-face after the peculiar intimacy of pregnancy. It makes us irrationally jealous of everyone and anyone; what mother doesn’t remember resenting the nurses and physicians who separated us from the baby long enough to do the general assessments and necessary care? Well, that is a reflection God’s love for each person.

If a person who is suffering is willing to enter into, and do, the hard work of therapy, which will include lifestyle changes and “homework,” and also becomes open to reconsidering his or her existence as a deeply loved person, someone who is more than the addiction, or bad choices, or terrifying memories, or intrusive thoughts and painful compulsions, then true and deep healing can happen.  This is what I would wish for every person struggling with emotional wounds.

Loneliness can kill you…part 3

This is the third of three posts. This one focuses on the art of conversation:  being better at conversation will help you overcome loneliness.  As noted in part 2 of this series, a lot of people struggle with reflection and/or asking questions that elicit a deeper conversation.

So, here are two strategies to help with these.

Reflection:  reflection has to do with being able to identify how someone else feels, and mirror that back to them with your expression and your words.  Laughing when someone tells you something sad (it happens, trust me) is not good. Identifying all negative emotions as some form of “mad” or “angry” is not helpful, either.  Sometimes, when you are watching a show, put it on mute and try to verbalize the emotions that characters are experiencing. Then go back and watch with the sound on. See how you did. Experiment with mimicking their facial expressions and see what feelings you experience; the imitated expression can trigger a shadow of the other person’s emotion via our mirror neurons.  If your emotional vocabulary is lacking, do an online search for Dr. Gloria Wilcox’ “The Feeling Wheel” for a research-based set of some of the many emotion words.

Asking questions:  there are plenty of sources for “conversation starters.” I have used Gary Chapman’s conversation starter cards for couples and for families with clients, as well as a discount store’s set of conversation starters for couples, families, and general-use conversation. Basically, at this writing, for about $1.25, you can get about 100 sample conversation starters. Here’s how to practice by yourself: pull a random card, look at the question, make up an answer someone might give, and see how many questions you can come up with related to that answer.

Random example:

Who was your favorite teacher?

And, here are just a few of the many possible questions to take the conversation further:

  1. What was special about this teacher?
  2. What is one of your favorite memories about being in that teacher’s class?
  3. Did other students feel the same way? Why or why not?
  4. How did having this teacher help you out in future classes with other, not-so-great teachers?
  5. If you could meet this teacher now, what would you want to say?
  6. Have you had any opportunities to help others the way this teacher helped you? What was that like for you?
  7. If you were going to encapsulate what you learned from this teacher as a “life lesson,” what would it be? How has that lesson reverberated for you since those days?
  8. Did you ever have a teacher who was sort of the evil opposite of this teacher? Who helped you get through that school year?

Practice making up questions. You won’t be peppering people with multiple questions; the goal isn’t to overwhelm people with an endless interrogation. The idea is to develop confidence that you can invite someone to have a richer conversation by asking a thoughtful question or two, and have the kind of dialogue that helps heal the loneliness that you, and perhaps they, are experiencing.

Because loneliness can kill you.

Loneliness can kill you…Part 1

According to new research from the journal Nature, Human Behavior published on January 3, 2025, loneliness and social isolation lead to molecular changes that, in my simple terms, seem to set the body up for serious problems – increased risk for dementia, depression, cardiovascular disease, diabetes, stroke, and early death.  The researchers’ recommendations include routinely asking about loneliness and isolation, the way a health professional asks about sleep habits, alcohol use, and drug use.

If you are lonely on an ongoing basis, this is for you.

Loneliness can strike through no fault of one’s own.

Losing your spouse, for example, or a best friend, will almost inevitably lead to a long stretch of deep loneliness during the initial year or so of grief, and can continue beyond, as the bereaved person struggles to outsource some of that emotional, intellectual and spiritual intimacy to other relationships. In a healthy marriage, you share all sorts of confidences with a spouse that you simply might not share with anyone else – fears, dreams for the future, spiritual insights and struggles, and the warmth of shared memories that are no one else’s but the two of yours.  Somehow, some of that must be extended to others, and depth built over time. It an absolutely monumental task to parcel out these small slices of the immeasurable depth of a healthy marriage.

Moving, alone, to a new city, for a new job, can be exciting, but the reality can include aching loneliness when everyone at the new job goes home to their lives and you go to your apartment and try to figure out how to build a life. Developing the big, and small, connections that make a place feel like home can be daunting, and for most people, it takes longer than they had ever anticipated.

Loneliness hits other people, too. Those who are living primarily second-hand, separated by screens and trying to substitute electronic connections for human ones, are often intensely lonely. Some people interact with others in person, but the conversations are shallow, guarded and therefore nearly empty of connection and meaning. This type of loneliness can be even more painful, because it seems inexplicable; how can a person live with family or a partner and yet feel deeply lonely?

So, what to do? Unfortunately, the impetus is mostly on the lonely people to do something differently.

Here are some suggestions I would give to a client in such a situation.

  1. Go to church or synagogue. If you are grieving, try to go back to your own – but if that’s painful, go somewhere else, at least for now. If you are new to the area, just find a place that seems like a possibility. Then go to the hospitality time afterwards. Introduce yourself, and invite people to tell you about the faith community. Do not stand around with your cup of coffee and wait for people to notice you. Set a goal: perhaps that you will introduce yourself to three people, get their names, and ask a little about this community. See what happens. Try to focus on the other person; make the conversation a chance to get to know them and about their community – not about you. If it goes fairly well, go back the next week, greet those three people (and anyone else you met) by name if you can, re-introduce yourself without taking them forgetting your name personally, and see if you can meet a couple of other people. Within a month, you will have some acquaintance with a dozen or more people and have a solid idea if this community offers activities for education, worship and service for you to join.
  2. Even if you usually like to do things solo join at least one activity – one exercise class, one art class, one talk at the local bookstore, etc. – on a regular basis. Get to be a regular. Greet other people.
  3. Volunteer in your community. Do this with others. Doing good solo is beautiful, but if you’re not getting out of your head and focused on others in an interactive way, you are missing part of the point.
  4. Be friendly but don’t try to bully people into being your friends. For example, if you are new to the area, don’t wear out your welcome with the neighbors who came over to introduce themselves on moving day.
  5. Please do not use alcohol or other substances, or resort to hanging out having drinks as a way to cut loneliness.
  6. Be patient and keep trying! Think of these steps as experiments. Track what happens over time; be willing to change to a different experiment if the first one isn’t working after a month or so.

As you can see, the remedies for loneliness all include getting out of your head and into the world. Focusing on others, in small ways (such as greeting them and showing interest) to big ones (such as volunteering), is a critical part of overcoming loneliness. This can be really hard, because loneliness tends to make people even more withdrawn, more insular – it is a self-perpetuating problem unless you boldly step out, even with small but courageous steps, into focus on others.

More about connecting with others in Loneliness can Kill You, Part 2, coming soon.

Why Ask Me That? Third in a series on questions in the therapy room

Someone who is struggling with anxiety just wants to feel better. It’s understandable; anxiety feels awful. The physical symptoms, so often hovering just below full-blown fight-or-flight; a mind that won’t rest, a brain that hops from topic to topic like a rabbit in a vegetable garden. Add to this the fear that so many people have when they come to therapy:  will the therapist tell me I’m crazy?

No; no, I won’t tell you that, but I am probably going to annoy you with a lot of questions that may seem to be irrelevant to your suffering. My paperwork asks about your history, decade by decade; your losses; job satisfaction; health issues; your alcohol and drug use; your prescribed medications; your exercise and sleep patterns. I ask about screen time, social memberships, supportive relationships. I ask a lot of questions, and I can tell who thinks those questions are irrelevant by who leaves them unanswered, handing me incomplete paperwork and acting surprised when I follow up on the many blank places.

All these questions are important, and here’s a short discussion on just a few aspects and the explanation.

Your sleep patterns, and any difficulties, can both contribute to, and be worsened by, anxiety, stress and depression. If you need more, or better sleep (and most people do), figuring some ways to improve your quality and quantity of sleep can help across many categories of your life: focus, memory, energy, stress level, and mood. When these improve, relationships can often improve, as you might expect when you can pay attention and be less cranky.

If you have major health conditions that are not properly managed, these may contribute to problems with sleep, anxiety, or mood. For example, poorly managed diabetes, besides being physically very dangerous, impacts focus and mood. I would refer you to your physician to see if there are problems that require medical attention.

Social isolation is a recipe for loneliness and depression. Social media use tends to make this worse – something that seems weirdly contradictory. Lonely people eventually withdraw, and this creates more loneliness, isolation and possibly anxiety and depression. We need to explore ways to enter back into activities with others.  From my guidance counselor days: children who are isolated suffer. If you ask a child if s/he has friends, and then ask him/her to name those friends, and there is a flash of hesitation, you know you are dealing with a child suffering social isolation. Just so, adults who cannot identify some supportive relationships and what is good about those relationships is an adult who is emotionally isolated.

I ask questions that make sense to me; if they don’t make sense to you, please ask why I’m asking. Thanks!

For Those Mourning a suicide

If you have lost someone to suicide, my sincere condolences:  peace be upon you in these incredibly difficult times.

I have been involved in grief counseling for a long time. I began volunteering as a grief support group facilitator about 20 years ago. Grief is always painful – the Irish language word clumsily translated into English as “Troubles” actually means tearing apart.  Losing someone to suicide is definitely a tearing apart, and one that carries particular burdens.

  • They are even more likely than other mourners to look backwards and try to reinterpret events to make sense of what happened. We humans like for things to “make sense,” even things that can’t be understood. Looking back can lead to a lot of unnecessary suffering – self-blame, recrimination, guilt.  Our culture pretends we can control just about everything, but we cannot. Through the lens of grief looking backwards, even a passing sad day years before can seem like a sign that was “missed,” and the perfectly normal little disagreement turns into the possible cause. Every memory is scoured for warning signs. The lists of warning sides of suicidality are helpful, but not all people have them. In reality, about 70% of suicides are impulsive acts – there are no real warning signs or markers, beyond the events of life that many people experience without becoming suicidal:  relationship struggles, financial struggles, legal struggles, job loss.  Some people will show some of the warning signs but are not be suicidal at all, such as someone who is enthusiastically minimizing their possessions in order to downsize. Please try to refocus on something else, even a small physical task, when you find yourself looking back to try to see what you “should have” seen: you are at risk of burdening yourself with unnecessary guilt.
  • Those whose loved one committed suicide are likely to hear even more of the hurtful things people can say to those grieving. Granted, most people’s hurtful remarks to mourners are well-intentioned, and yet incredibly unhelpful, such as the dreadful, “You’re still young…you’ll have other children,” or, “You should be glad they’re not suffering any longer.”  There are some people, though, who say truly, intentionally horrible things about those who commit or attempt suicide, and this leads mourners to lie about the cause of death and/or isolate from others.  Avoid these people; seek the company of those who are compassionate.
  • Those who have lost someone to suicide are especially likely to avoid going to grief support groups, or will only go to those about suicide.  I encourage going to a general grief support group, too; it can be a place to learn a lot of skills and strategies that are helpful to all mourners, and can be that first, safe place to talk about what really happened and get support as you manage the tangle of terrible emotions. You will find strategies and support for how to take one step at a time into a world that seems to no longer make sense. Please do not isolate out of pain, unnecessary shame or unnecessary guilt.
  • See your primary care doctor, avoid any mind-altering substances, and try your best to follow medical guidance – even though you will often not feel like eating right or exercising.
  • Seek individual or family counseling to help with the grief process as needed.

And, of course, as this is not psychological guidance or advice – just information and encouragement – reach out for help if you are struggling with suicidal thoughts or fear for someone else. Besides your health care provider, the local emergency room, or 911, you might call the National Suicide Hotline at 988 or the 1-800-273-TALK (8255) National Mental Health Hotline.

If you are reading this and thinking of someone you know who has lost someone to suicide, please reach out with compassion. Be present; keep reaching out. Invite for simple things; offer specific help (with chores, for companionship, to go with them to a grief support group because going is, at first, absolutely terrifying). Please do not ask a lot of questions about the death; if the person is open, instead ask about the person: the happy memories of the past. Ask if you can help and don’t be surprised if you hear, “I’m fine,” or, “You can’t bring them back,” or, “I don’t need anything.”  In that case, come back another time with specific offers (“Can I come by sometime and help with the lawn?” “Are you up for a cup of coffee at the park?” etc.).  Be gentle with people who have been torn apart.

Thanks for reading.

The Serotonin Story

Unless your newsfeed features obscure psychiatry and psychology news, UK news, or the very limited US news coverage of the July 2022 publication of “The serotonin theory of depression: A systemic umbrella review of the evidence,” in the Journal of Molecular Psychiatry, you might not have heard this news. In a sweeping meta-analysis addressing six serotonin-based hypotheses and multiple studies, one of over 150,000 people, the conclusion has been drawn that, verifying what the senior author of the article, Dr. Mark Horowitz, noted is “known in academic circles, that no good evidence has ever been found of low serotonin in depression (Medscape, July 22, 2022).”  The evidence does indicate, in some studies, that long-term use of some antidepressants can lead to lower serotonin levels, just as long-term use of drugs that boost dopamine (amphetamines, for example) can ultimately lead to depletion and insufficiency of that neurotransmitter.

To repeat, in the academic world, it has long known there is really no substantive evidence linking low serotonin levels to depression. This is similar to the academic knowledge that marijuana, especially in its modern, heightened THC formulas, is a dangerous road to sometimes unrelenting anxiety or even psychosis.  However, since science is hard and so often inconvenient, these particular unpopular truths have usually been ignored. About one in six Americans, and about one in six English adults, are on antidepressants.  Yet the science says the rationale for these drugs – that they will fix a chemical imbalance in the brain – does not stand.  The science does seem to indicate a placebo effect, as well as some people experiencing a numbing of emotional pain, which might be sufficient to begin the work of the changes necessary to heal from depression. The researchers are quick to note that no one should stop these medications quickly; cessation ought to be done slowly, with medical supervision, because of the risk of physical and psychological ill effects during withdrawal.

Depression, as Dr. Horowitz’ team and countless other researchers and clinicians have long asserted, is a complex experience of physical, emotional, cognitive and social aspects.  It is also a rather fluid diagnosis, encompassing, as it does now in the current diagnostic manual, almost any two-week period in which sufficient symptoms are met, even when life’s events make it a completely normal response.  As I have noted in other articles, the grief exclusion for depression has been eliminated, for example. Are we, therefore, to believe that, once someone you love dies, you develop a potentially lifelong brain disease in which one neurotransmitter (among many) suddenly goes haywire?  Or is it feasible that death, or profound injury, or the loss of a job or home or friendship, etc., could cause sadness, physical pain and fatigue, and a tendency to withdraw from the very activities and relationships that could bolster recovery?

One of the interesting aspects of this study was its analysis of the very popular genetic explanation, a sort of, “It runs in my family,” explanation for depression.  Besides the scientific analysis of the large body of research indicating that that while a very small, initial study hinted this may be the case, the much larger research studies indicate it is not.  Of course, there is more to “running in the family” than genes. Some of this may be impacted prenatally via epigenetics, which helps tell which genes to turn “up” or “down” (a grotesque oversimplification; sorry) depending on environmental stressors such as severe poverty and want of food.  Then our families teach us whether the world is a safe place or not, and whether to take risks or not. Optimally, families teach us we are worthwhile, and how to make connections and corrections in relationships.  They set a life pattern in place that may ses us up for long-term healthy habits, or inflict a neglected or violent childhood that results in shortened telomeres and the prospect of an unhealthy and too-short adulthood. If the family fights dirty, abuses substances and one another, is rejected by the community via being fired repeatedly from jobs, ostracized by neighbors, and disliked by peers, the children will grow up to be unlikeable, rejected, angry and depressed adults.  There need not be any genetic component for this to be the case.

This type of adult will need to learn to heal wounds, how to develop a sense of purpose and meaning, and the cognitive skills to overcome depression. The latter includes developing the skill of interrupting and redirecting rumination, challenging and changing unhealthy thought and behavior patterns and thus changing emotions, and improving the skill of being in the moment, or, as Dr. Stephen Hayes has written, “Get out of your head and into your life.”

There are biological factors at play; anyone who believes they are suffering from depression ought to have a full physical exam, including bloodwork, to rule out medical causes for many of the symptoms of depression.  Good guidance on nutrition, sleep, exercise and natural light exposure are all in the physical realm of helping, and deficiencies in any of these areas may be sufficient to trigger the low mood, lack of energy, erratic eating and sleeping identified with depression.

There is, as can be seen, nothing here that is so complex that it is beyond the average person’s ability to understand and do.  For most of human history, the rhythm of sleep, hard work, natural light, meaningful connections with others and a strong accession to the transcendent provided a milieu in which profound suffering had both meaning and support. Our lives were designed for mental health.  This, alone, is so reassuring and empowering that one would think that this simple, ancient recipe for mental health would have never been relegated to a supporting role. Unlike the message that your brain is broken and there is nothing to be done except take this pill – which may make you suicidal, or homicidal, or cause tremendous weight gain, sexual difficulties, apathy, or moments of mania – the message of the Horowitz et al research is a hopeful and inspiring one: that it is possible to overcome the depression that threatens to crush your spirit.

Military Mental Health

It seems as if daily we are told how shamefully the military handles the problem of psychological distress and emotional pain for our men and women in uniform. In May, the USA Today newspaper empire asserted that the “Pentagon [is] perpetuating stigmas that hang over treatment, study finds.” (Zoroya, USA Today, May 6, 2016). The military is criticized because it takes mental health issues seriously enough to reconsider security clearances…unnecessarily “stigmatizing” those who have sought treatment.

This supposed stigmatization merits careful consideration. These include the depth and breadth of existing mental health services for active duty personnel and veterans; the conflicted American mindset on mental illness and emotional distress; and the logical outcome of this strange ambivalence.

A person not in the military or close to military personnel, may reasonably be under the carefully groomed media misimpression that the emotional well-being of our soldiers, sailors, airmen and marines is some sort of vague afterthought. Perhaps the general public is unaware that military mental health officers (people who are qualified to be licensed solo practitioners in the civilian world) are found in forward operating bases, combat outposts, and other deployment settings, providing critical incident debriefings, assessments, counseling, and referrals for more comprehensive care. When young men in harm’s way are despondent over a wife’s philandering, or are heartbroken over missing their child’s birth, the mental health officer is there. When there are incoming mortars, the mental health officer is there. When someone’s reaction to the weekly required malaria medication is extreme (malaria meds cause short-lived anxiety in about 1 in 10 people, and for some of that 10%, paranoia kicks in briefly, too), the mental health officer is the one who can figure out what’s going on and have the physician provide an alternative medication for the soldier – saving a military career from dissolving due to what looks like psychosis but is a transient medication side effect. In short, when crises occur, the “doc” or “shrink” or “combat stress lady” (quotes from military personnel) is there.

It is understandable that most civilians are unaware of mental health clinics on military bases, where military personnel and their families can receive counseling. Besides basic counseling services, mental health personnel provide services such as outreach before, during and after deployment, support while preparing for new babies, parent training, marriage counseling, couples’ retreat weekends, substance abuse education, and more. All these are part of the routine in military mental health clinics. Mental health officers are also able to veto a transfer if any member of the transferring family’s health or mental health needs cannot be adequately met at the new location. So…if Mom is being transferred to Base “A” and that area doesn’t have the specialized services that one child in the family needs, the transfer is nixed – possibly by a licensed clinical social worker at Lieutenant rank. The 2nd Lt. just overrode the entire command structure, in the military that is decried for not taking mental health needs seriously.

Then there are the VA system and the Vet Centers. Vet Centers are cousins of the VA. Unlike the VA, Vet Centers require only a DD 214 to provide free individual, couple or family therapy. It doesn’t have to be service-related…but if the problem seems to be service-related after all, the Vet Center personnel can help facilitate connection to the VA proper. These, too, are staffed by people licensed in their respective states as solo practitioners. There are no “not good enough to make it in private settings” amateurs serving in mental health positions.

Finally, there is the difference between benefits (think, Tricare, which is insurance for post-military service) versus service-connected health care (think, the VA system). A lot of veterans get that confused, and any of us who have tried to deal with health insurance and making sense of what is/is not covered, copays and coinsurance, and in and out of network…well, it’s understandable that almost anyone would find it confusing. Fortunately, the VA system and Tricare have professionals who do a lot of work (and get yelled at a lot) in trying to help people understand their benefits/insurance/service-connected health care, and connect them to the right services.

There are mental health services for military personnel and veterans. There could certainly be more, and the services available could be better marketed. In addition…there are stigmas.

Those stigmata comprise one more disgraceful example of too many Americans wanting to have their cake and eat it, too.

The regrettable medicalization of mental health has resulted in the mythology – happily embraced by many in the medical, pharmaceutical and professional-helper fields, as well as by many in the general public – that all mental disorder diagnoses are brain diseases. For example, many professionals will assure you that depression is strictly medical in nature; a brain disease, incurable but treatable by manipulating brain chemistry. Likewise, anxiety is (supposedly) purely a physical issue. People collect Social Security Disability, disability from their employers’ insurance, and other benefits, based upon having some sort of lifelong brain disease (according to psychiatry).

There are plenty of people eager to buy into this. We hear depression is epidemic (what else could we call something that apparently affects at least 20% of women and 10% of men each year, based on prescriptions for drugs?). Well, here is a recipe for depression:

  1. Maintain a sedentary lifestyle
  2. Eat a lot of junk food and assiduously avoid adequate portions of healthy foods
  3. Smoke cigarettes and/or abuse illegal or prescription drugs
  4. Drink more than one drink daily (females) or two drinks daily (males), or more than your physician recommends, given your particular health profile.
  5. Cultivate poor sleep habits. Watch television before bed; heck, watch television in bed, or use your smart phone, or tablet, etc. at bedtime. Drink caffeine less than six hours before bed. Wait until night time to argue with your spouse. Have a “nightcap,” which is a short word for “the alcoholic drink that will let you fall asleep more quickly and then wake up at 2 AM and have difficulty going back to sleep.” Eat salty foods before bed to activate your dopamine system and feel a little hyper.
  6. Avoid exposure to natural daylight.
  7. Watch lots and lots of television, or streaming video, or play video games, or surf the internet. The more the better. Strive for the national average of 6 hours or more daily (non-work related).
  8. Spend lots of time on social media. In particular, notice how much your life stinks compared to other people’s (supposed) lives.
  9. Shop for recreation. Spend money you don’t have on things you don’t need and then keep being surprised when, no matter how fancy the clothes or pricy the electronics, you are still, well, you.
  10. Be selfish.
  11. Don’t apologize, and don’t say thank you.
  12. Think a lot about how much other people are unkind, selfish, lazy, and how generally you are not getting your fair share.

Yes, I just described what an awful lot of people do, and yes, if you do enough of these things, you will probably feel depressed. Yet, as can be seen, every single one of these behaviors is optional for most people. Perhaps someone has physical challenges that prevent them from being active, but otherwise, these all represent choices made, choices which could be changed. If you were to do these things, and feel sluggish, unhappy, uninterested in life, helpless to make things better, etc., and reported this to your doctor, you could easily be diagnosed with depression.

The label depression, of course, is itself suspect. Within the mental health field, we are well aware of a dirty little secret. This secret is carefully hidden by pharmaceutical companies from the unsuspecting, suffering, and happiness-seeking public. That is, the criteria for almost every mental disorder diagnosis is a checklist. Committees review the research, argue about what should and should not be on the various checklists, have professional feuds, and publish the criteria. People are then diagnosed based off a checklist of symptoms or complaints. Those categories are fuzzy – a complaint I hear regularly from graduate students who, perhaps naively, expect pure, clear science. As soon as one set of criteria is published, the process starts all over again. This is how it came to be that, in the current diagnostic manual for the American Psychiatric Association, there is no such thing as bereavement. If you are still moping around after two weeks because someone you love has died, the American Psychiatric Association, in its infinite wisdom, has decided you meet criteria for Major Depressive Disorder. That’s the same Major Depressive Disorder diagnosis that many forces are pushing us to believe is simply a brain disease that requires lifelong treatment. I am not being sarcastic or flippant; it’s their decision, not mine. I was Hospice-trained and, even absent that, I am human and understand that bereavement is a long and painful process, even for the resilient among us.

The decision to eliminate the “bereavement exclusion” was supposedly made, in part, to allow people to use health insurance to pay for grief counseling. (At least, that’s the gossip I hear in mental health circles.) In other words, you are despondent. Someone has died. You go to a counselor. They diagnose you with depression, which is supposedly a brain disease, because you meet checklist criteria. You are now labelled with what many people assert is a lifelong condition due to your sick brain. You will now be able to have insurance cover your counseling (after your deductible has been met, of course). The diagnosis of a major mental disorder will last forever – long after you have forgotten whether you paid a copay or full fee for a handful of sessions, or went to a support group in a church conference room that a therapist facilitated as a volunteer.

Depression is worth discussing as one of the most common diagnoses. Psychiatrists and other physicians provide prescriptions for antidepressants, for example, to about 15% of the adult population annually – and many assert that depression is just a disease, like any other disease, and you have to face that you will be sick and need medication for the rest of your life. If that is the case, then why criticize the Pentagon for being concerned about someone whom psychiatrists assert has a lifelong brain disease having their finger on a trigger, or button, or sensitive data? Why should one person with a particular diagnosis be placed on perpetual disability and another maintain top secret clearance? Which do the people complaining about how the military stigmatizes mental health want?

To be clear, this is not unique to the military. People seek counseling, are unwittingly diagnosed, and discover later that they are deemed mentally ill and a high risk for suicide; perhaps their life insurance rates increase, or their health care premiums increase, and when the premium bills come in, they can’t remember having any mental problems except that time they saw a counselor after their grandparent passed away. The labelling can happen without any mental health treatment at all; if your physician lists a mental disorder as a possible diagnosis (fatigue, depressed mood, and poor sleep being symptoms of lots of problems, psychological and physical) while ordering blood tests (for what turns out to be something medical), that possible mental disorder diagnosis is in your health record, now part of your profile, even if you turned out to be anemic, not depressed.

Even if you are diagnosed with depression, the diagnostic categories don’t adequately describe what is happening, and they should. It is reasonable to expect that professionals, viewing the diagnosis on a chart, immediately discern the difference between these types of experiences:

“I’m depressed and exhausted because I’m having hideous nightmares ever since my buddy was blown up and died in my arms” versus,

“I’m depressed and exhausted because the 5 years I spent doing meth have caught up with me and my brain has been damaged,” or,

“I’m depressed and exhausted (and right now no one, including me, realizes it’s because I am among the one in 10 women who suffer depression as a side effect of chemical birth control).”

Right now, the label doesn’t differentiate. As you dig into the chart, yes, it’s there – but the most superficial record just shows the diagnosis code.

So, let us not pretend that the military is some big, horrid bully for treating serious mental disorder diagnoses as a possible risk factor for clearance. As long as those in power – throughout the medical, insurance, pharmaceutical and government arenas – are manipulating the definition of mental illness, one can hardly blame the military for being overly solicitous about the mental health of our men and women in uniform.

The conundrum of diagnoses and the risk of damage to one’s life explain why some military personnel are suspicious about seeking mental health treatment. We ought not to assume ignorance when they instead go to chaplains (who may be precisely who is needed) for wise and useful guidance. Similarly, they may choose to be self-paying for marriage counseling, stress management or other issues…off the record and off the base, their privacy is as sacred as mental health treatment ever was, before psychiatry yielded to intrusive insurance, and, as the big player in the mental health field, dragged most mental health professionals with it.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.