The Role of Medication
Where appropriate, medications may be recommended, particularly for those individuals struggling with a serious depression or debilitating anxiety. However, it is neither my place, nor my practice-style to “push for” medications, which is something I hear many patients complain of. Believe it or not, doctors do not get “kickbacks” from pharmaceutical companies for prescribing their drugs, so there is no “hidden agenda” if I do recommend something – the only “bonus” I get will be a sense of satisfaction if a particular medication is able to alleviate someone’s painful symptoms.
Only you can know what is best for you; medication may be a route you prefer to avoid, or, you may find it helpful to think of medication as just one of many “tools” you might choose to help dig yourself out from under a difficult situation. Either way, your choice is respected, and the “prescription” for your recovery will be one we design together, as a team working towards a common goal.
How a Therapist Differs from a Friend
I would describe my personal approach as friendly and supportive, while also disciplined and organized. I care a great deal about the well-being of those who choose to share their problems with me. In this manner, a therapist is much like a friend, and some people do think of their therapist in these terms. Unlike a friend, however, it is also my job to push people to take responsibility, and to challenge them to consider how their thoughts and behaviours may, routinely, result in them “getting in their own way.” And, unlike a friendship, there’s no expectation between us of “reciprocity” – that is to say, you don’t need to listen to my problems, or help me solve them! The time we have together is reserved just for you.
Martial & Relationship Counselling
“My husband and I fight all the time. We even do it in front of our kids. We’re both sick about it – we know how damaging it is for them to hear us fight – but it’s like one of us, or both of us, gets “set-off,” and then off we go. We’re just so different – sometimes I can’t remember why we even got together in the first place. However, we’re still together, and we both want some better strategies for working things through. If divorce is where the path leads us, I think we’d be able to face it, but we’re so busy arguing, we’re not even “on the path,” anymore. Instead, we’re pulled over to the side of the road, bickering, while life is passing us by.”
Criticism. Arguing. A feeling of being disrespected or unappreciated by the one who we think – we hope – knows us best. All couples disagree, however, the health of a relationship can be measured by the skill with which two individuals can come together, and work through disagreements without compromising their respect for each other.
With couples – whether young or old, straight or gay, married 30 years or dating less-than-a-month – it’s my job to observe how individuals interact with their partner, and to provide feedback where I see the potential for problems beginning, hopefully even before the relationship has gone totally “off the rails.” In this way, too, a therapist differs from “a friend,” the latter whose primary allegiance is often only to “half” the couple – that is, to their friend. In contrast, my allegiance, first and foremost, is to the relationship itself; time and again, I’ve observed that people are often more committed to their partner and to their relationship, than they care to admit, and I’m continually impressed by the lengths many people are willing to go to “keep love alive.” At its best, couples therapy can help individuals learn how to communicate with their partner more effectively, while at the same time, reminding them of the special connection they alone share.
Other times, there really is “no love left.” In these situations, a couple still needs to come together to work through the difficult, emotionally painful process of separation and/or divorce. In this situation, too, a good therapist can help, providing an objective overview of what’s at stake, while helping the couple to “come apart” in ways that ensure each person remains whole and heard.
Living Well & Coping With Chronic Illness
“I was diagnosed with MS when I was 20. I was at university at the time, and I honestly thought my symptoms were from staying-up late, studying. It was hard being at university and suddenly being told I was “sick” – and with a serious illness – when no one else around me was. People worried about such petty things – whether they’d get into Professor Mark Easy’s class, or whether Professor Eve N. Stephen would let them write the exam so they could go to the Dominican on Reading Week. Meanwhile, I’m worrying if I’ll end-up in a wheelchair. Who would want to date me then? Heck, who’d want to date me now, knowing this could be how I “end-up” – or worse? I’m only 24 years-old, and I have to think about all these depressing things that no one else does. I worry all the time, so was diagnosed with anxiety, and now I’m depressed, too. It just feels so unfair.”
My first job as a doctor was in the Student Health Clinic at Queen’s University here in Kingston. I soon recognized that I could help more (and more kinds of) people from the perspective of a private practice – but not before I took note of the surprising frequency with which serious, chronic illnesses arose in young people. I was likewise alarmed at the even-greater frequency with which mental illness seemed to arise in young adults who most would consider privileged and “problem-free.”
Over the years that I worked there, I identified a number of factors specific to university studies and campus life which, unwittingly, set university students up for failure at what I believe to be a far higher rate than their working peers – or even those of equivalent age studying at college. I see each of these factors as playing a key role in allowing, and even encouraging, mental illness to develop; with these factors left unaddressed, I believe university students will continue to suffer from mental illness at rates disproportionate to those of their working or college peers.
Depression, Anxiety, Self-Doubt – The Tangled Triangle
Depression
“My girlfriend left me and I just can’t get past it. I keep hoping that she’ll change her mind and take me back. Friends tell me to “just move on,” but when I think of dating someone new, I feel sick to my stomach. I’m embarrassed to admit that she’s been gone now more than a year, and I feel just as stuck as ever.”
Depression is not the same things as feeling sad or bored or nostalgic. It’s a mental illness which should not be confused with “normal” sadnesses such as disappointment, discouragement or grief, which are typically time-limited types of emotional distress, triggered by a specific event. In fact, depressive episodes can often be traced to an initial inciting event (often a loss), but the feeling of distress is more pervasive, often described as a constant feeling of hopelessness, discouragement or despair. Depression can taint our entire world-view, and left untreated, can progress to the point where suicidal thoughts occur and where the notion of “leaving it all behind” can seem like a rational choice.
Anxiety
“My boss is constantly on my back. I’m a good worker – I know that – but I’m slower than the others, because I’m detail-oriented and because I feel that things to be done to a very particular, very high standard. I have an assistant, but it’s hard to me to delegate work to him, because I know that few people are as exacting as I am. I’ve been called a perfectionistic, and I admit that I don’t mind, and maybe even like it. But it’s getting in the way of work, and if I’m honest, it’s been a problem at every job I’ve had. It’s at the point now where, if I don’t adapt, I won’t move ahead in my career. Now, I find myself constantly worried that I could be fired, and what then?”
Where depressed people often find themselves ruminating on the past – wondering how they might have said or done this or that differently – anxious people look to the future, and always through a fearful, sometimes even catastrophic, lens. There are many different types of anxiety. Non-specific worries that arise seemingly for no reason are often described under the umbrella term, “Generalized Anxiety Disorder,” while extreme, irrational fears related to specific objects or situations are termed, “Phobias.” Some people experience “Social Anxiety,” where they fear being judged and found wanting by other people, and so they will fear – and possibly avoid – situations which bring them into contact with others. “Panic Disorder,” is yet one more manifestation of anxiety, in which a person experiences recurrent, unexpected “panic attacks,” which are sudden, inexplicable periods of intense fear, accompanied by a feeling of foreboding and doom. “Obsessive Compulsive Disorder,” often simply shortened to “OCD,” is a condition where the sufferer experiences recurrent, intrusive thoughts of an unwanted, often distressing nature (obsessions), coupled with a variety of repetitive, seemingly non-sensical, even superstitious behaviours (compulsions), which – for reasons even the sufferer can’t explain – appear to temporarily quell the anxiety associated with the unwanted obsessions.
Self-Doubt
“You know the grey, stuffed donkey in Winnie-the-Pooh? Eeyore? That’s me. Always gloomy, always down, always expecting the worst. My friends kid me about it; they call me “a pessimist,” or “a glass half-empty kind of guy.” I can’t say they're wrong – that really is how I see things. I’d like to be more upbeat, more positive, more hopeful about the future. But I’ve felt this way for so long now, I just don’t know how.”
Some people aren’t exactly anxious, and aren’t exactly depressed, but they feel “off.” They doubt themselves, their abilities, and their value, both in their immediate circle of influence, and in the world at large. Often, these folks will be diagnosed as, “dysthymic,” which refers to a sort-of depression where the symptoms are milder, but longer-lasting; in some cases, people can be dysthymic nearly their entire lives.
Though self-doubt isn’t itself a “disorder,” persistent self-doubt will lead to, and invariably reinforce low self-esteem, which is a common precursor to both depression and anxiety disorders. The experience of being constantly anxious, sometimes for years on end, will commonly lead to depression, while the experience of depression is itself often accompanied by non-specific worries and one or more of the specific anxieties described above. In this manner, depression, anxiety and self-doubt often work reflexively to reinforce one another, creating a “triangle” whose three-sided “stability” can be challenging to break.
