Social Anxiety Disorder

Young man with social anxiety disorder isolated inside by window

Paralyzed By Socializing

Social anxiety disorder is a chronic debilitating mental illness that prevents one from socializing in public out of fear of ridicule. It may stem from childhood, a specific type of temperament or even genetics. Usually it has to do with a child’s upbringing and social interactions.

As with anything in life, if bad experiences dominate a child’s upbringing, they will learn to associate them with negative and uncomfortable feelings; it’s called classical conditioning. In Pavlov’s experiment, he brought a dog a piece of steak while ringing a bell, causing the dog to salivate at the sight of the steak.

The dog then learned to associate the sound of a bell with being fed. Pavlov then observed that the dog would salivate when the bell was rung, without the piece of steak present. That’s because the dog’s brain learned to anticipate food with sound. The same occurs in mental illnesses like panic disorder, social anxiety disorder and PTSD.

Children may constantly be bullied or be made fun of for the way they dress, talk or behave. Early social embarrassment in addition to a shy or reserved temperament is the perfect recipe for social anxiety disorder. As children enter adolescence, they become even more self-conscious.

Adolescents who don’t develop social anxiety disorder have learned to adapt by building up their confidence, avoiding negative crowds and finding friends who appreciate them for who they are. These factors help them develop healthy social encounters.

Adolescents who do not adapt to their social surroundings are the ones who may develop social anxiety disorder. They fear going to school or even being in public because they have learned to associate their presence with a negative social outcome. Rather than adapting, it’s as if they are paralyzed in fear of ridicule.

And this is how the disorder develops. The more a person avoids socializing, the more strength the disorder gains; to the point of even developing agoraphobia. To help prevent social anxiety disorder from developing in the first place, children and adolescents need not care what others think about them!

It’s your life! Don’t allow others to terrorize it. You are beautiful just the way you are!

Are you Ready? (This is Defeating Stigma Mindfully)

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The Past: Potently Sweet But Aggressively Poisonous

Clear hourglass healing the past besides pink flowers

Nothing Heals The Past Like Time

The past is very special because it’s a recollection of events which you can never get back. The memories are the only way you can relive the past and attempt to feel that bit of pleasure you once felt. The saying “stop living in the past” is true to a certain extent.

If your past is preventing you from enjoying the present, then you must stop living in the past. Most people who live in the past are stuck; they long for whatever it was that once brought them pleasure. They don’t know how to let go, so they continue living like there’s no tomorrow (no pun intended).

But if you are leading a healthy and productive life in the present, living in the past can actually be good for you. It’s healthy to reminisce or to indulge in enjoyable recollections of past events. It helps you become more appreciative of the nice things that life has done for you.

Every person in this world has experienced an unfavorable event in their lifetime. Sometimes the event is so awkward, painful or annoying that you wonder how you will ever get rid of it. It’s called time. Time is the master healer of the past. Time doesn’t erase the past; it just helps human consciousness move beyond it.

Something bad from the past will never be erased from your record. What’s done is done. But one can heal and grow from the adverse experience and that is where time comes in handy. It buffers the experience away like a bad scratch on your new blue Mercedes-AMG GT 4-door Coupe.

So don’t sit around and ruminate about the past if you have gone through a bad experience. You will only cause yourself more stress and increase your chances of developing depression or anxiety. Allow time to do the healing for you by just moving on with your life and letting go of the painful memories.

The past is like a double-edged sword: it can be potently sweet but aggressively poisonous as well.

Are you Ready? (This is Defeating Stigma Mindfully)

2019 World Mental Health Day

Colorful together signage painting

Talking One Language

Mental health stigma, suicide or substance abuse . . . these problems continue to prevail in all corners of the world despite advancements in medical and psychiatric research. In the United States, suicide has become the second-leading cause of death among college students.

More people are hearing about mental health but many are still not receiving treatment. A lot of people around the world are too afraid to speak out about their illness, out of fear of ridicule. Many people around the world also do not have access to mental health services; a psychiatrist may be as close as a 3 hour drive.

Depression and anxiety continue to plague all levels of society, whether rich or poor. There is no correlation between money and mental health; one may be a billionaire and still develop depression or a substance use disorder. Even among the 1%, talking about mental illness is often a challenge.

The root of the problem is ego: we are afraid to be more open about mental illness out of fear of injuring our ego. Rather than seeking the proper help and care for an illness, we attempt to keep the symptoms to ourselves, or worse, hidden from ourselves. Many people attempt to ignore their symptoms, believing that this cannot be happening to them.

Rather than creating a worldwide platform for sharing our struggles with mental health, we are beating around the bush by avoiding talking about something difficult or unpleasant. Rather than treating humanity, we are treating segments of humanity; the whole remains divided into pieces.

Pieces do not solve the larger problem. We must come together and open up regarding our struggles with mental health; there is no shame in being sick! Shout it from the rooftops if it has to be done. We have the chance to change the way society views mental health, so future generations can come into this world experiencing a comfortable place to seek help and treatment.

It’s time for us to talk one language: mental health.

Are you Ready? (This is Defeating Stigma Mindfully)

Invisible Voices

Psychotic patient experiencing disturbing auditory hallucinations

Auditory Hallucinations In The Brain

The scientific belief is that when auditory hallucinations are experienced, there is too much dopamine in the mesolimbic tract of the brain. It is not clear why too much dopamine causes auditory hallucinations. But when a patient experiences invisible voices, it feels very real to them even if they have no basis in reality.

These invisible voices may be females, males or both. The voices may talk to each other or directly to the person. Some patients describe hearing voices of other patients on the unit talking directly to them in their head. You may notice when a patient is experiencing voices by the dysphoric appearance on their face; especially when they previously denied hearing voices and never had a dysphoric appearance.

Many psychotic patients, especially chronic ones, do not want to get rid of their auditory hallucinations. Initially, they may have a desire to experience improvement, but over time, many develop tolerance to the invisible voices and don’t mind their persistence.

This is because some psychiatric patients become so used to experiencing auditory hallucinations, that they would not know how it would feel without them. Like any person in life, once you become comfortable with a certain situation, making a change is not on your immediate agenda.

It is important for patients to tell their psychiatrists the truth regarding the content of their auditory hallucinations. Oftentimes, these invisible voices may make the patient feel uncomfortable and even command them to hurt themselves or others. When a patient is most vulnerable, such as being depressed or angry, is when these voices have the greatest chance of influencing the patient.

Antipsychotics do a very good job at alleviating the voices; for some, the voices go away altogether. But it is important to know that as with any medication, there comes the risk of side effects. In the case of antipsychotics, these may include:

  • EPS
  • Metabolic syndrome
  • Diabetes
  • Weight gain
  • Sedation

. . . and the list goes on. But the benefits often outweigh the risks. Who can actually live a normal life experiencing auditory hallucinations? The importance of taking the antipsychotics to help treat the voices trumps the concern of developing weight gain and sedation.

One can live a fairly normal life with weight gain and some sedation neutralized by caffeine. But can one live a normal life with a demonic-animalistic voice yelling at them in their head?

Make the right choice. Seek treatment.

Are you Ready? (This is Defeating Stigma Mindfully)

Down In The Dumps

Depressed brunette woman in bathtub with hands over face

Depression Stole My Soul

Depression lurks around like free-floating bacteria; you can catch it as easily as catching a cold. Many people are depressed and do not even know it. In children, depression may present as irritability. A very common initial presentation of depression reported by patients is fatigue; “I feel tired all of the time.”

Many people don’t want to admit feeling depressed; they see it as a weakness. They think that it can’t be happening to them, so they experience denial. But denial does not take away depression; if anything, it makes it worse. Depression strives in denial; it wants you to stay in that state of mind.

Some people are so depressed that they can no longer function. They report that they have to force themselves to eat; it becomes a chore. Some will not get out of bed all day; they will remain paralyzed for hours at a time, only to get up to use the bathroom. Imagine no sunlight entering your home and laying like a corpse for 12 hours at a time!

The worst thing that you can do for a depressed person is to not take their condition seriously; this can actually be the trigger for them to pull the plug and end their life. When you are suspicious of someone being depressed, believe it! And help them seek help before it’s too late.

You have no idea how much help you can be to a person who has had their soul stolen by depression. In their eyes, you become like their guardian angel, giving them hope and guidance. But if their guardian angel disappears, what is left for them to keep pushing forward? Usually . . . not much.

Don’t allow depression to keep spreading like an evil virus, consuming everyone who enters its path. The more we open up to each other, the easier it will be to overcome depression. But if we remain isolated, selfish and ignorant, many people will continue living in pain; many will also continue to end their life.

Together we can.

Are you Ready? (This is Defeating Stigma Mindfully)

The Art Of Psychopharmacology

Psychiatrist's hand surrounded by green LED lights

Prescribing Psychiatric Medications Wisely

Our psychiatric patients rely on us for first-hand knowledge on medications that can treat their mental illness. But without consistently studying the different mechanisms of action, side effect profiles and indications of these powerful psychotropics, we are doing our patients a disservice.

Pharmacology makes up a large component of the psychiatrist’s toolkit; perhaps around 40%. The other 60% is the human being behind the psychiatric mask: the personality of the psychiatrist, their intentions, passion and the love and care for their patients.

You can have the best intentions in the world, but without a strong grip on psychotropic medications, you will not be able to effectively treat your patients. Because the treatments in psychiatry are very subjective, and what works for one patient might not for another, it becomes very important to remain flexible in your care and management.

Are you able to discern whether to add a mood stabilizer or augment an existing antipsychotic with a second antipsychotic? You must be able to come up with smart and effective reasons as to why you are choosing one medication over the other. Medications are costly, cause side effects and contribute to polypharmacy.

You might not always be on the same page with a psychiatric patient in regards to agreeing on a particular medication, but you should always provide informed consent and be able to explain your reasoning for the addition of a new medication. The patients rely on your expertise.

It’s called an art because nothing is set in stone. Even though the science says one thing, the individual human being might react differently clinically. Therefore, applying the science while mastering the art of psychopharmacology will increase your chances of developing a stronger therapeutic alliance with your patients.

Your patients rely on you to deliver them from their mental illness. And you rely on three factors: science, art and love!

Are you Ready? (This is Defeating Stigma Mindfully)

Persistence With Psychiatric Patients

Lavender-colored flowers

Do Not Give Up On Treatment

Psychiatric patients oftentimes need reassurance that a certain treatment will be beneficial. The sound of a tricyclic antidepressant causing cardiac problems or electroconvulsive therapy inducing seizures can be understandably scary and concerning. Do not ever push a certain therapy onto a patient unless it’s an emergency.

Emergencies include suicidal ideation, past suicide attempts or current severe depression. Even substance abuse may be considered an emergency if the patient has a history of depression and overdoses, and is currently using. No matter what the situation is, always be kind with psychiatric patients; you are the potential healer of their suffering.

Persistence is important with psychiatric patients because many times, their judgment is too impaired to make rational decisions. For instance, many severely depressed patients in state hospitals are non-responsive to multiple antidepressants; their only hope is ECT.

But many patients refuse ECT out of the fear of feeling the electroconvulsive shocks being delivered via electrodes placed on the temporal regions of the head. The chances of feeling the shocks are slim to none, considering that anesthesia with Brevital, an anesthetic barbiturate, is given at a dose which induces sleep within 10 seconds, for a duration of 5-7 minutes.

The actual convulsions, on average, do not last longer than 180 seconds. The point is that psychiatric patients need persistent explanations and reassurance that a certain therapy has the potential of being beneficial. Giving up on a certain therapy because a patient consistently says “no” is giving up on your patient!

Do not settle for mediocracy. Psychiatric patients need persistent, healing human beings who do not give up on them. An excellent psychiatrist attempts to put him or herself in that patient’s shoes, in order to try to understand their perspective and where they are coming from.

Be that excellent psychiatrist. Be that caring healer. Be that loving human being!

Be.

Are you Ready? (This is Defeating Stigma Mindfully)

Struck By Catatonia

Young man in a catatonic stupor looking down at ground

A State Of Trance

Catatonia is a state of abnormal movement and behavior arising from a disturbed mental state, typically from schizophrenia. But catatonia can also occur independently of schizophrenia. When a patient is in a catatonic state, it is very obvious. They may demonstrate mutism, negativism, resistance to passive movement or repetitive and purposeless movement.

Some patients who are catatonic urinate and defecate on themselves. They have no logical explanation as to why they do it. They may say that they “didn’t have enough time to get to the bathroom.” That being said, you would think that they would at least clean up after themselves. Wrong. Catatonic patients can remain soiled in feces for hours at a time if undetected by staff or family.

You may repeatedly instruct a catatonic patient to shower because they are soiled in feces, but they will not react. They may enter the bathroom and just stand there, giving no logical reason as to why they are refusing to shower. Often, Ativan 2 mg IM must be given to catatonic patients; it helps them to snap out of it.

Some catatonic patients can be observed to be non-responsive in bed for hours at a time. You can ask them how they are doing and try to help them get out of bed, but they will just stare back at you with an expressionless face as if they just had a stroke. But no stroke has occurred. They are just in a mental state called catatonia.

It is important to remain patient with catatonic patients and to not lose your composure. It can become frustrating to have a catatonic patient not react to your verbal commands, but just be cognizant of the fact that catatonia is a mental illness. Many patients cannot even explain to you what catatonia feels like.

It just happens. So do your best to remain composed, professional and supportive. We are all in this together!

Are you Ready? (This is Defeating Stigma Mindfully)

Unique Keys To Mental Illness

Focus photography of psychedelics used for treating mental illness

Psychedelics For All Walks Of Life

Can chemical compounds such as DMT, psilocybin, LSD and mescaline be one day utilized to treat mental illness? MDMA is already in phase 3 clinical trials for the treatment of PTSD. Defeating mental illness has already proven to be a difficult challenge for the medical community, with many drugs simply not touching the pathology responsible for these destructive conditions.

Psychedelics may one day prove to be unique keys to mental illness because of the altered states of consciousness in which they provide. It’s not necessarily their mechanism of action in the brain which is proving to be useful, but the meaningful and profound experiences which they provide for users.

Many patients in clinical trials have reported relief in their anxiety and depressive symptoms after having meaningful trips on psilocybin. The idea is that hallucinogens force the user to confront their troubles and unconscious conflicts directly in the trip; their madness comes out in a controlled and supervised medical setting.

Perhaps anxiety and depression is much more complex than the monoamine hypothesis of not having enough serotonin circulating in the synaptic cleft. Perhaps the reason why psychedelics are proving to work against these mental illnesses is because they directly tackle the unconscious conflicts which have gone haywire; psychedelics help the user untangle the intricate and sticky unconscious webs.

One exciting point about hallucinogens is that they’re non-addictive; no one wakes up everyday and states, “I want to trip on ibogaine today.” This is because hallucinogens provide such powerful experiences, that the mind simply does not have energy to “trip” on a consistent basis. This prevents users from becoming addicted.

Throughout history, psychedelics have been regarded as sacred medicines used for guidance, learning and healing. They were even previously used in the field of psychiatry in the 1950s before they left the laboratory and blew up into the free love social movement. In return, the Nixon administration viewed hallucinogens as a threat to the mind and soul of America’s youth and made them schedule I drugs; the research was buried underground.

As more traction is gained regarding the research studies on psychedelics, maybe one day we will be able to utilize these powerful medicines to help alleviate mental illness, and provide a higher quality of life for people from all walks of life.

Are you Ready? (This is Defeating Stigma Mindfully)

What Does Malingering Mean?

Young man showing photo of himself malingering

Malingering Versus Factitious Disorder

To malinger is to exaggerate or feign an illness in order to escape duty or work. There are many malingerers in the world of mental health. Some attempt to avoid long prison sentences by feigning a mental illness: they may try to act psychotic or depressed and suicidal. Some are successful and are sent to a psychiatric state hospital; others return back to prison to serve the remainder of their sentence.

Another example of malingering is a homeless person wanting shelter as winter is approaching. They will enter a hospital emergency department and make up various symptoms such as, “I had a seizure“, “I had a stroke”, “I’m really sick, my stomach has been killing me.” If the neurologist or ED physician is experienced, they will easily catch on to the malingering.

Factitious disorder is when a person presents with real symptoms in order to assume the sick role; they have an unconscious desire to be treated like a patient. They may self-inject fecal material in order to acquire a bacterial infection or self-administer insulin in order to become hypoglycemic.

Patients with factitious disorder are usually female nurses or hospital employees who have general knowledge of the healthcare system and desire upfront medical attention. There is even factitious disorder by proxy, where a person will make their child or elder sick in order to assume the caretaker role!

The clear difference between malingering and factitious disorder is that the former is a conscious act; the latter is a conscious act motivated by an unconscious desire. Malingerers find an excuse to obtain a get out of jail free card, while patients with factitious disorder have unconscious conflicts that become the drivers behind their behavior.

If you find a patient who is unwilling to cooperate with medical procedures and evaluations and paints a sketchy picture, then you have just met a malingerer. If you find a patient who is a middle-aged female and has a medical track record of entering many different hospitals in a short period of time for suspicious and questionable activity, then you have just met a person with factitious disorder.

Welcome to the world of mental health!

Are you Ready? (This is Defeating Stigma Mindfully)