Wednesday, November 06, 2019

Psychiatry and Psychology

Sadly, even in our modern society, many people misunderstand psychiatry and psychology issues. That is unfortunate because no one blames people with cancer or asthma or diabetes. Hopefully by understanding more about psychiatry and how the brain works, we can be more understanding of ourselves, friends and family members that might be struggling with these issues or might struggle with these issues in the future. 

Psychiatry is divided into 2 parts called Axis (Axis 1/Axis 2). Axis 1 involves chemical imbalances in the brain and can be treated with both medication (psychiatry) and talk or group therapy (psychology).  Talking to a counselor is very important, but talking alone will not fix the problem if there the brain has a chemical imbalance. Sometimes only medication can fix an imbalance.  Eating a good diet and exercise can also help and should be tried first before meds. 

The main psychiatric issues are:

1. Depression (feeling overly down):
2. Anxiety (feeling overly nervous):
3. Attention (hard to focus):
4. Unstable/Bipolar (up and downs):
5. Thinking Disorder/Psychosis (not thinking right):

Depression and Anxiety can be helped with medications that balance brain chemicals Seretonin and Norepinephrine like Prozac, Zoloft, Celexa, Effexor, Cymbalta. (SSRI, SNRI). 

Many kids have attention problems and take medications like Concerta or Adderall they help them pay better attention in class. 

Some people fluctuate with extreme ups and  downs. These people can be put on medications like Depakote, or Topamax that help stabilize their mood. 

Other people have trouble thinking and might see, hear, or feel (fear) things that are not real. These thinking problems can be treated with medications that balance Dopamine in the brain. Medications that help with dopamine are Ability, Seroquel, Risperdal or Zyprexa. 

It is normal for everyone to feel down or anxious or both sometimes. Just because you feel down or anxious some times doesn't mean anything is wrong.  The problem is only if the depression or anxiety is making it so you can't go to school, church, family events, or work.  You also need to have the problem longer than 6-months. You likely have friends on these meds and don't know it. 

In the previous section we talked about Axis 1 problems involving a chemical imbalance that can be helped with a combination of counseling, diet, exercise and medications.  Another issue that psychiatry and psychology deal with are Axis 2 problems. These problems are much harder to treat.  In fact, there are no medications for Axis 2 problems which are also known as personality disorders. 

Axis 2 personality disorders like Axis 1 chemical imbalances are not the person's fault . Axis 2 problems develop in childhood and are usually the result of a childhood trauma (something bad happened), or parents not giving enough of the right kind of attention and/or discipline.

It's very normal for kids and teenagers to behave in some Axis 2 ways.  However, good parenting will help kids grow out of these behaviors that would make adulthood difficult.  Like Axis 1 problems, Axis 2 problems can interfere with family, church, work and school. 

Most Axis 2 personality disorders come from a deep, negative feeling of not being loved.  Some counselors refer to these as "self-love deprevation syndrome". The difficult behavior comes from sub-consciously trying to protect themselves from being emotionally hurt.  Many people who might have an Axis 2 problems might have a mixture or parts of several of these problems. 

Axis 2 problems are really hard to deal with.  The people that have them don't know they have them, and don't see that there is a problem. They are supremely  offended if you were to even suggest it. They think that their behavior is who they are and it's part of their personality style. They are not consciously or purposefully trying to be difficult or emotionally hurtful.

Most counselors/psychologist say Axis 2 problems never get better because the person who has them doesn't know they have it and will get immediately defensive and angry at the suggestion that there might be an Axis 2 problem.   The behaviors get worse with stress, and as people get older. They don't grow out of it. 

Axis 2 problems have become more common with the Millennials and later  than ever before.  Performance-based self-esteem vs. self-worth based on knowing you're a child of God leads to greater insecurity and Axis 2 problems. If your value is based on performance, health, image, then your self-image crashes if you fail, so people raised under the concept of self-esteem fight to protect image even if it's a false image. If your value is based on God, no failure or setback can take your intrinsic  self-worth away. People with a healthy concept of self-worth are better able to deal honestly with their weaknesses/failures and improve. (Brene Brown Vulnerablility).

Axis 2 Personality Disorders include:

Overt Narcissism PD - thinking regular relationship rules don't apply to you because you are special and an exception. These have trouble taking advice/criticism from others. Difficulty with people who think different than them. (President Trump)

Victim/Covert Narcissism PD - thinking regular relationship rules don't apply because you are a victim and had an unfair/hard life. These also don't like to take advice/criticism and often feel and remember things worse than they really were (victimization). Think love equals 100% conforming to their way of thinking. Not interested in others ideas. Sometimes negative feelings focused on single person  (scapegoat). 

Borderline PD - fear of abandonment, throw a public tantrum if they don't get their way.

Hystrionic PD - need to be center of attention.

Antisocial PD - hurt small animal.

Dependent PD - difficult time making decisions. Ask others to make decisions for them. 

Schizoid PD - avoid people and groups. Like to be alone. They aren't anxious around others, they just prefer to be by themselves. 

Schizotypal PD - magical thinking (superstition, superpowers) and living in a fantasy. 

Obsessive-Compulsive PD - Overly clean and overly detailed