![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by cybercafe on March 21, 2003, at 16:07:41
can someone help me. I wonder how to communicate to my doc how depressed i am (i am not depressed in his office).
other than hurting yourself is there a way to say "Wake up buddy! i feel like crap and i seriously need some help"
is there a rating scale other than HAM-D (it seems to cater more to melancholic types whereas i'm atypical)?
Ugggg ritalin is so good but so bad
Posted by mair on March 21, 2003, at 16:32:53
In reply to self-injury/suicide only options??, posted by cybercafe on March 21, 2003, at 16:07:41
My therapist doesn't quite understand why I can't just tell her - she thinks that I should explain that even if I don't think I'm at risk to hurt myself, I feel awful enough to be thinking about it all the time.
It's always so much easier to just talk "around" things.
I think no matter how difficult, I guess you should just try a more direct approach and make it clear that how you feel while you're sitting in his office is not how you feel when you're not there.
Mair
Posted by justyourlaugh on March 21, 2003, at 18:30:30
In reply to Re: self-injury/suicide only options?? » cybercafe, posted by mair on March 21, 2003, at 16:32:53
oh my,
i cant say anything to pdoc in his office,
he askes"if i want to hurt myself"-i say im not "suicidal"then he writes crap down....
does she/he know you are capable?..were you?
i guess you could use words like"hopeless..end of my rope..if you want to dance around...
or mabe just say how frustrated you are....giving up...write it down on paper..and if you cant say it...pass it to him..
sometimes if we "respect" someone ,we feel are in a higher position,(md) we may not want to let them down..by telling them their"solutions"are falling flat....
take a visit to the fridaynight er ...talk to an oncall..they will help too....
jyl
Posted by fayeroe on March 21, 2003, at 18:39:24
In reply to Re: self-injury/suicide only options??, posted by justyourlaugh on March 21, 2003, at 18:30:30
Have you considered in-patient care for awhile?
It sounds like you and your therapist aren't on the same wave-length at all. In in-patient, the therapy would be intense and personal. Good luck. pat
Posted by sienna on March 21, 2003, at 18:47:18
In reply to Re: self-injury/suicide only options??, posted by fayeroe on March 21, 2003, at 18:39:24
i think it depends where yougo inpatient. i have had where it is a lot of therapy and i have had where there is next to none but mostly med changes and waiting for you to not be suicidla so they send you back home.
I recommend trying to tellyour t how serious it is. I know that is hard. I have had really hard time with that too.
sienna
Posted by syringachalet on March 22, 2003, at 0:18:43
In reply to Re: self-injury/suicide only options??, posted by sienna on March 21, 2003, at 18:47:18
Many depessed people self-injure because they can tolerate the physical pain they are feeling easier than they can the mental pain they feel they have no control.
For some it is a form of release or relief. They have been emotionally hurting so long or so deeply, they have had to numb themselves from the mental pain just to survive.
By causing themselves physical pain, they tell me that 'they feel alive'.
Some have even told me 'it was like they would rather be kick than ignored by the world'..I would like to suggest a possible option to vent some of those negative feelings that need to released.
Maybe try writing down how you feel when youre really anxious would help. Lots of people who are very depressed feel overwhelmed and things look pretty hopeless sometimes.
I have had clients who had things going on in their lives that for whatever reason they didnt feel comfortable talking about it when they were sitting in my office.
For some just the act of writing it down, they could vent some of their negative feelings.
Some of them drew pictures, some wrote poetry, others simply expressed their fears, frustration and anger about what was causing them to be so upset. They used whatever medium that worked for them.With each visit, I started their alloted time asking if they could share at least one of the things they had written during the time since our visit. I found great insight in having them share things from their point of view. It helped me start to understand what was causing them to be so anxious and I was better able to talk to the pdocs about what was and what wasnt working for this client.
Our goal is to keep the client functioning within the community in the least restrictive environemt as safely possible.
Please consider this option. My expereince has been that it will be a win-win for you both.. you and your T...
Please keep us posted. Safe cyber-hug if Ok.syringachalet
Posted by Dinah on March 22, 2003, at 9:28:02
In reply to Re: self-injury/suicide only options??, posted by syringachalet on March 22, 2003, at 0:18:43
> Our goal is to keep the client functioning within the community in the least restrictive environemt as safely possible.
>Syringachalet,
May I ask you about that statement if you don't mind? I've always found that to be my therapist's goal. Keeping me functioning is the supreme goal. And to some extent that makes me almost murderously (towards myself of course) angry at times. Because it seems as though the pain doesn't matter as long as I'm functioning. Which may be my distorted perception stemming from that pain.
It leads to some pretty nasty thoughts about how no one really cares I feel as long as I "act" ok. Thoughts that have plagued me since my breakdown as a preteen. When I started pretending to be ok, stopped causing trouble for my parents, everyone was happy. Everyone but me. Even though I tried to convey in every way I could short of misbehaving like I had previously (in other words I functioned) that I was NOT ok, that I was in incredible pain, no one listened or it seemed, cared as long as I was no trouble. As long as I kept the false self firmly in place.
None of this is directed of course to you, and of course stems from long - long standing resentments and buried anger.
But as someone who works in this area, and whose words are similar to what I've detected in my helpers and my parents and, well, everyone do you think you could give me some insight into the way of thinking. Some insight into how my thoughts may be distorted?
Thanks,
Dinah
Posted by Dinah on March 22, 2003, at 9:28:39
In reply to Re: self-injury/suicide only options??, posted by syringachalet on March 22, 2003, at 0:18:43
Posted by noa on March 22, 2003, at 10:54:37
In reply to Re: self-injury/suicide only options??, posted by Dinah on March 22, 2003, at 9:28:02
One thought I have about that is that letting one's functioning go is a slippery slope! Keeping us going in our routines, roles, relationships, daily lives can provide stability. I guess it depends, though. I would think that sometimes, people kind of need a crisis to shake things up, but then the goals would be to get functioning again. But that would only help if the crisis really shook things up enough to lead to helpful changes. Lots of smaller crises usually doesn't have that effect.
I think looking for people's strengths and trying to bolster them probably helps most people. For myself, my depression/anxiety feeds on itself, and the longer I go letting my better functioning slip away, the harder it is to get it back, and the more hopeless I feel. Reminds me of when I was 8 years old and had one of those awful flus that they used to name for places--I think this one was labeled the "Hong Kong Flu". I was out from school for 3 weeks before I was better enough to go back. Well, come that Monday morning when I was returning, I remember crying while getting ready. I was panicked, I think, about being able to go back to my role as a student in my class, with my peer group, etc. I was simply out of practice, really, if you think about it. It was like school phobia all of a sudden. I had had a bit of separation anxiety in certain situations when I was much younger than that, but never had school phobia, but after this long absence, I was terrified. I had a vague sense of not being able to fit in again, of people not knowing me, and I think, of me not knowing myself in those roles--student, peer, etc. What ended up happening was I went for 2 days and then had a "relapse" in my illness for the rest of the week. I am positive, and I may even have had such an awareness then, that I wasn't sick with any lingering flu symptoms, but with anxiety. Those 2 days were all I could handle in readjusting to my functional life.
I guess the question of being allowed to "let go" with ones' feelings also depends on how hard it is to pull back together after letting go. For many people letting go is very risky. I think there is recent research on anger showing that letting it all out is not, as the freudian "steam heat" model used to suggest, the best way to manage anger. Not that holding it all in and seething is healthy either! But I think the idea is that letting go and getting really angry can be too agitating for mind and body.
OTOH, if one's ability to pull oneself back together, to soothe oneself, is good, then I would think letting go is less of a problem.
Given what you've described as your experiences of extreme agitation soemtimes, with risk of self injury, do you think your therapist is trying to "contain" and has concerns about letting you let go?
Posted by syringachalet on March 22, 2003, at 12:12:52
In reply to Re: self-injury/suicide only options??, posted by noa on March 22, 2003, at 10:54:37
Noa,
As usual you show such great insight into what many of us are facing everyday and even more so now when it seems everyones stress level is at 'heightened alert'...
I have learned over the years that for most of us much of our depression is based on the feelings that 'their world is spinning out of control' and thats why they feel so lost.(My clients also tell me this often.)
By trying to help people maintain some kind of balance or 'routine' in their lives, it helps them have some structure in the hourly day.
Having somewhat regular hours that you sleep and are active help you feel physically better and able to mentally deal with those situation that occur in your your daily life.(Routines are esp important for children.. they tell me they feel safer.)I came to the rude realization a few years ago that I cant make anyone be "happy". Helen Keller said it wheh she stated, "Happiness must come from within."
I do care for all my clients but for me to be too emotionally involved with anyone of them would both drain me and potentially cause them to become depended on me.
That is something any reputable therapist would not want for the long haul.
I cant help them with their issues if I get too emotionally involved and cant keep my eye on "the big picture" of keeping them safe.Besides what I think that might make you happy might not be right for you... that should be your decision...
I do my best that my clients have all the physical things they feel they need.
I encourage them to use both the services available as well as those 'natural supports'(if they have family,friends,church,etc) to build their support system that meets their own needs.By encouraging my clients to build their own 'structural framework', they decide at what level many of the people in their world are involved. Some of the people are going to be in their system there because they have to be and others are of limited avaliability.
The goal is for each client to start to feel 'empowered or 'more in control' of those things in his life that he can and is ready to control.
In the beginning, that might not be much but over time, I have had clients who went on to college or vocational school, marry and had families( I honestly was a little considered for a few on this topic).
Some have come back to see me or send me notes or Christmas cards) sharing their triumphs and those times when they slipped up a little and had to 'get back on the horse'.. HELL havent we all???
I guess I hope that people can remember that happiness isnt like a train station you arrive at, but its the traveling and learning to enjoy the everyday things in your lives and knowing that only person you can truly control you and the only person who can truly make you happy is...
you know.Take Care. Be Well.
syringachalet
Posted by Dinah on March 22, 2003, at 12:24:02
In reply to Re: self-injury/suicide only options??, posted by noa on March 22, 2003, at 10:54:37
I don't know, Noa.
Certainly I want to stay employed and be a good wife and mom. And I don't like what I was before I decided to act as if I was ok. It didn't do me any good, and my life was better after I learned to act "as if". And I'm not terribly happy that my mask has started to slip too much at work. I don't like feeling out of control.
I guess I just still have some resentment that concern for me at the time mainly had to do with having me conform to expectations, and that once I did so everything was considered ok, when I knew full well it wasn't ok. No real effort was made to address my feelings except to the extent that they affected my actions.
Part of me agrees with that, part of me hates it. It sets up that whole "Richard Corey" sort of dynamic.
Posted by cybercafe on March 22, 2003, at 14:14:04
In reply to Re: self-injury/suicide only options??, posted by Dinah on March 22, 2003, at 9:28:02
> None of this is directed of course to you, and of course stems from long - long standing resentments and buried anger.
>
> But as someone who works in this area, and whose words are similar to what I've detected in my helpers and my parents and, well, everyone do you think you could give me some insight into the way of thinking. Some insight into how my thoughts may be distorted?yeah i know how you feel... my doc thought ritalin was working because i was working
he just didn't understand that i was really toughing it out, praying that next week would be the week i would get a magical med and things would be betterone of the reasons i quit my job
Posted by Dinah on March 22, 2003, at 16:22:13
In reply to Re: self-injury/suicide only options??, posted by cybercafe on March 22, 2003, at 14:14:04
Yeah, I understand completely. It's enough to tempt you to quit functioning. But I don't recommend that. As I said, I did it once (not deliberately of course) as a preteen and it *doesn't* make life easier. Suicide or self injury also are not the answer to not being taken seriously.
If you can't impress on your doctor how badly you feel, and how important it is to feel better, find yourself another doctor. You're an adult, you are the consumer, and you have a right to have your pain addressed.
Despite my complaints about their emphasis on functioning, my therapist and pdoc both take me seriously. I just have some leftover issues from my youth, and am oversensitive about it. I never feel like I need to act out to get their attention. Don't accept less for yourself.
Posted by noa on March 22, 2003, at 21:38:48
In reply to Re: self-injury/suicide only options?? » noa, posted by Dinah on March 22, 2003, at 12:24:02
Dinah, I hear you. Especially for someone like you who is so good at appearing to be OK when you are in terrible emotional pain!! You've had to be the good girl, smile on face, all your life. Hiding the pain inside. So the last thing you want is for your therpist to take your face at face value and not acknowledge that how you appear to the world may not reflect how you feel inside.
Posted by syringachalet on March 22, 2003, at 21:54:47
In reply to Re: self-injury/suicide only options??, posted by noa on March 22, 2003, at 21:38:48
I have been in a counseling situation that the client thought I could'read their minds' or somekind of body language and I some how missed it that day.
I know what its like to have to try to keep your 'game face on' when your personal life sucks.I guess for me, personally, its that I have worked too hard and come too far to have everything I worked so far for to be taken because I had a mental melt-down.
I dont have everything I want in my life but I do find joy and happiness in many of the things and people I do have.
For me to expect someone else to make me
feel better about myself is unrealistic and
would be a relationship doomed to fail.
Some people get married thinking that they will have this other person who will make them feel like a 'whole person'.
I think you have to feel like a 'whole person' all by yourself. I feel that marriage should only add to who you are and how you feel about yourself; never take away.
I feel having unrealistic expectation in any relationship is unfair to both parties.syringachalet
Posted by Dinah on March 22, 2003, at 22:34:11
In reply to Re: self-injury/suicide only options??, posted by noa on March 22, 2003, at 21:38:48
Thanks, Noa.
But I think to some extent I let old hurts influence my view. Despite his emphasis on function, he does hear what I tell him. And takes it seriously.
Posted by cybercafe on March 23, 2003, at 16:39:43
In reply to Re: self-injury/suicide only options?? » cybercafe, posted by Dinah on March 22, 2003, at 16:22:13
> Yeah, I understand completely. It's enough to tempt you to quit functioning. But I don't recommend that. As I said, I did it once (not deliberately of course) as a preteen and it *doesn't* make life easier. Suicide or self injury also are not the answer to not being taken seriously.
well i just had to quit work because i didn't see a point in toughing it out anymore.. my doctor didn't seem like he was going to give me a change of meds anytime soon .. the job also sucked
i apologize if i gave the impression i was in danger of self injury/suicide, i certainly didn't want to worry anyone, just communicate the way doctors seem to think
> If you can't impress on your doctor how badly you feel, and how important it is to feel better, find yourself another doctor. You're an adult, you are the consumer, and you have a right to have your pain addressed.
you're right of course ... but this guy is really really good and he seems to be a caring person... just busy :(
and i don't want to have to wait 3 months to see another doc... i really want to just move to europe and pay someone for treatment so .. they will take the time to listen to me
now that i think about it .. i'm sure there are more options than self-injury or suicide ... a wise move for me might just be to not shower, shave for a week
> Despite my complaints about their emphasis on functioning, my therapist and pdoc both take me seriously. I just have some leftover issues from my youth, and am oversensitive about it. I never feel like I need to act out to get their attention. Don't accept less for yourself.i dunno.. for one thing my doc says i can't take certain drugs ... and i just find it hard to believe him (since i see other people taking them)
Posted by cybercafe on March 23, 2003, at 16:48:05
In reply to Re: self-injury/suicide only options?? » cybercafe, posted by mair on March 21, 2003, at 16:32:53
> My therapist doesn't quite understand why I can't just tell her - she thinks that I should explain that even if I don't think I'm at risk to hurt myself, I feel awful enough to be thinking about it all the time.
>
> It's always so much easier to just talk "around" things.
>
> I think no matter how difficult, I guess you should just try a more direct approach and make it clear that how you feel while you're sitting in his office is not how you feel when you're not there.
>
> Mairmy doc thinks i'm not very depressed and should try cognitive treatment rather than adding meds
i'm trying CBT ... but i'm getting worse not better
Posted by cybercafe on March 23, 2003, at 16:56:52
In reply to Re: self-injury/suicide only options??, posted by justyourlaugh on March 21, 2003, at 18:30:30
> oh my,
> i cant say anything to pdoc in his office,
> he askes"if i want to hurt myself"-i say im not "suicidal"then he writes crap down....
> does she/he know you are capable?..were you?
> i guess you could use words like"hopeless..end of my rope..if you want to dance around...
> or mabe just say how frustrated you are....giving up...write it down on paper..and if you cant say it...pass it to him..
> sometimes if we "respect" someone ,we feel are in a higher position,(md) we may not want to let them down..by telling them their"solutions"are falling flat....
> take a visit to the fridaynight er ...talk to an oncall..they will help too....
> jylsorry i don't mean to give the intention i'm in danger of self injury
a drastic action for me would be to start taking meds without letting him know
(like add some lithium) .. but i havn't given up on my doc yet .. ug...yeah i don't know if my doc's ego is involved.. or if he is just too busy ... or maybe i'm not that bad ... is it bad when it takes a couple hours to get out of bed and you find it hard to cook/shower/dress ?
i dunno... i feel my ADD isn't treated... i feel my depression isn't treated... i just feel a lot needs to be addressed :(
Posted by cybercafe on March 23, 2003, at 16:59:04
In reply to Re: self-injury/suicide only options??, posted by fayeroe on March 21, 2003, at 18:39:24
> Have you considered in-patient care for awhile?
> It sounds like you and your therapist aren't on the same wave-length at all. In in-patient, the therapy would be intense and personal. Good luck. pati'm not bad enough to get in patient care ...
that's the problem... i know i have a lot of potential but i'm not bad enough for the docs to care :(
Posted by justyourlaugh on March 23, 2003, at 17:14:20
In reply to Re: self-injury/suicide only options?? » fayeroe , posted by cybercafe on March 23, 2003, at 16:59:04
too funny,
looks like we have you all put away neatly in the hospital-lol
jyl
Posted by sienna on March 23, 2003, at 18:32:16
In reply to cyber, posted by justyourlaugh on March 23, 2003, at 17:14:20
hi
i know that sreallly frustrating. i have that problem too its wierd i cna be on the verge of hanigng myself nad noone notice but then i am freaking out but i know is not like as bad as before and alll the sudden im in intensive outpatient program. but i know i need to be there is just wierd why they dont send me before.I havent figure out the way to explain things to my doctor. I think its very hard sometimes to have them actually hear what you are saying. I dont know how to get messages across. And ltos that time i think they read between lines thatat arnet there and dont believe the things i am saying.
i hope you are feeling a littl ebetter. im glad you arent going to do anything but im sorry you are feeling so crappy. they wont give you meds? i dont understand that. im not sure too much about CBT, but i think that is helpful sometimes but meds can be necessary too.
anyway im rambling so i will stop.sienna
This is the end of the thread.
Psycho-Babble Social | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.